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Schizophrenia Update
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Series 2, Issue 7 - December 11th, 2002
A Summary of Schizophrenia News and Events
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Table of Contents
Merck Research Chief Plans to Step Down to Pursue Treatments for
Mental Illness
Edward Scolnick to Return to Labs, Seek Methods to Treat Mental Illness
By GEETA ANAND
Staff Reporter of THE WALL STREET JOURNAL
Merck & Co. said its head of drug research, Edward Scolnick,
was stepping down after 17 years and plans to go back into the laboratories
as a scientist pursuing treatments for mental illness, a personal
crusade motivated by a family history of psychiatric disease.
December 11, 2002
Brain Imaging May Detect Schizophrenia in Early Stages
By ERICA GOODE, New York Times
Scientists have known for some time that people who suffer from
schizophrenia show abnormalities in the structure of their brains.
But in a new study, researchers for the first time have detected
similar abnormalities in brain scans of people who were considered
at high risk for schizophrenia or other psychotic illnesses but who
did not yet have full-blown symptoms. Those abnormalities, the study
found, became even more marked once the illness was diagnosed.
The subjects in the study who went on to develop psychoses had less
gray matter in brain areas involved in attention and higher mental
processes like planning, emotion and memory, the researchers found.
Experts said the study's results, reported yesterday in an online
version of The Lancet, the medical journal, offered the possibility
that imaging techniques might eventually be used to predict who will
develop schizophrenia, a devastating illness that affects more than
2.8 million Americans. Doctors could then offer treatment while the
disease was still in its earliest stages, possibly preventing further
damage to the brain.
But Dr. Christos Pantelis, an associate professor of psychiatry at
the University of Melbourne and the lead author of the report, cautioned
that much more research was needed before magnetic resonance imaging,
the method used in the study, could serve as a diagnostic tool for
individual people with schizophrenia.
"I think it's still too early to say how helpful it will be,"
Dr. Pantelis said.
Still, other researchers called the study's findings exciting and
said that the areas of the brain in which the abnormalities were found
would now be an active focus for study.
"This is a terrific first step," said Dr. Paul Thompson,
a professor of neurology at the University of California at Los Angeles
and an expert on brain imaging and schizophrenia.
Dr. Herbert Y. Meltzer, a professor of psychiatry at Vanderbilt University
and an expert on schizophrenia, said, "It proves that the psychosis
is almost a late stage in the evolution of the disease process."
He added, "The key message is that this is a neurodevelopmental
disorder and that changes in memory, learning, attention and executive
decision-making precede the experience of the psychosis."
People who suffer from schizophrenia typically experience auditory
hallucinations and have blunted emotional responses and difficulty
with activities that require planning or other higher-level processes.
Some studies have suggested that the earlier the illness is treated
with antipsychotic drugs the better the prognosis. At least two research
groups, one led by Dr. Patrick McGorry, an author of the Lancet report,
and another at Yale, are conducting studies in which young people
who are experiencing some symptoms but have not yet developed schizophrenia
are treated with antipsychotic drugs. But the studies have been controversial
because it is not yet clear which symptoms predict later illness.
In the new study, the researchers used magnetic resonance imaging
to scan the brains of 75 people who were deemed "at high risk"
for psychosis because they had a strong family history of severe mental
illness or had other risk factors, including transient or mild symptoms
of mental disturbance or a decline in mental functioning.
Over the next 12 months, 23 of the subjects developed a full-blown
psychosis and 52 did not fall ill, the researchers found.
A comparison of the brain scans from the two groups revealed significant
differences in the volume of gray matter in areas of the frontal and
temporal lobes and the cingulate gyrus. All three regions have been
linked to schizophrenia by previous research, Dr. Pantelis said.
When the researchers conducted additional brain scans on some subjects
who developed psychoses, they found further reductions in gray matter
not seen in the scans taken before the illnesses were diagnosed.
===========================
From the University of California at Los Angeles:
10 Keys to Recovery From Schizophrenia
UCLA Neuropsychiatric Institute researchers have identified 10 key
factors to recovery from schizophrenia. The findings open opportunities
to develop new treatment and rehabilitation programs and to reshape
the negative expectations of many doctors, patients and their families.
Based on analyses of the professional literature and the cases of
23 schizophrenia patients who successfully returned to work or school
with their symptoms under control, the findings appear in the November
2002 edition of the International Review of Psychiatry.
Factors detailed in the study that influenced recovery included 1)
family relationships, 2) substance abuse, 3) duration of untreated
psychosis, 4) initial response to medication, 5) adherence to treatment,
6) supportive therapeutic relationships, 7) cognitive abilities, 8)
social skills, 9) personal history and 10) access to care.
"Our findings join a growing body of research that flies in
the face of the long-held notion that individuals diagnosed with schizophrenia
are doomed to a life of disability with little expectation for productive
involvement in society, a fatalistic view that in itself is damaging
to prospects for recovery," said lead author Dr. Robert P. Liberman,
a research scientist at the UCLA Neuropsychiatric Institute and professor
of psychiatry at the David Geffen School of Medicine at UCLA.
"By understanding the dynamics of recovery, we can design more
effective courses of treatment and combat the pessimism held by many
doctors, patients and families struggling to cope with this debilitating
disease," said Liberman, director of the UCLA Psychiatric Rehabilitation
Program and Center for Research on Treatment and Rehabilitation of
Psychosis. "Increasing the rate of recovery from schizophrenia
will help destigmatize this disease, reduce the emotional burden on
families, and lighten the financial weight on communities, states
and the nation."
Liberman and his collaborator, Dr. Alex Kopelowicz, medical director
of the San Fernando Mental Health Center and associate professor of
psychiatry at UCLA, edited the November 2002 edition of the International
Review of Psychiatry. Their articles are joined by those from an international
array of investigators on the process of recovery, prospects for improving
schizophrenia treatment and suggestions for future research.
Factors identified as keys to recovery from schizophrenia included:
1. Family relationships: Family stress is a powerful predictor of
relapse, while family education and emotional support decrease the
rate of relapse. Among study participants, 70 percent reported good
or very good family relationships.
2. Substance abuse: National Institute of Mental Health research
estimates the prevalence of lifetime substance abuse among schizophrenia
patients at 47 percent, well above the overall rate. Though three-quarters
of the study participants reported substance abuse prior to treatment,
just 17.4 percent reported abuse after the onset of schizophrenia.
None reported illicit drug use in the past year, and just two reported
occasional alcohol consumption.
3. Duration of untreated psychosis: Longer duration of symptoms prior
to treatment correlates directly with greater time to remission and
a lesser degree of remission. Among study participants, only 13 percent
reported a delay of more than a year between the onset of symptoms
and treatment.
4. Initial response to medication: Improvement of symptoms within
days of receiving antipsychotic drugs significantly predicts long-term
results of treatment. Among the study group, 87 percent reported effective
control of symptoms with their first antipsychotic medication.
5. Adherence to treatment: Failure to take antipsychotic medication
as prescribed hampers both short-term and long-term recovery. All
study participants reported adherence to psychiatric care and medication
regimens.
6. Supportive therapy: Positive relationships with psychiatrists,
therapists and/or treatment teams engender hope and are essential
to improvement. Among study participants, 91 percent reported ongoing
psychotherapy, and 78 percent reported that accessible and supportive
psychiatrists and therapists contributed to their recovery.
7. Cognitive abilities: Neurocognitive factors such as working memory,
sustained attention and efficient visual perception are strong predictors
of recovery. Among study participants, all showed normal or near normal
functioning on tests of flexibility in solving problems, verbal working
memory and perceptual skills.
8. Social skills Negative symptoms, or poor interpersonal skills
relative to social expectations, correlate with the degree of disability
caused by schizophrenia. No study participants showed more than very
mild negative symptoms.
9. Personal history: Premorbid factors, or those in place prior to
the onset of the disease, that affect treatment outcome include education
and IQ, age of onset, rapidity of onset, work history, and social
skills. Among study participants, level of education was used as a
measure of premorbid history. A total of 70 percent graduated from
college before becoming ill, and an additional 13 percent completed
two years of college. Three of the remaining four subjects worked
full time before their illness began.
10. Access to care: Continuous, comprehensive, consumer-oriented
and coordinated treatment is crucial to recovery. Among study participants,
91 percent reported receiving antipsychotic medication and psychotherapy,
47.8 percent social skills training, 56.5 percent family participation,
26 percent vocational rehabilitation, and 61 percent benefits from
self-help groups.
The study:
Schizophrenia encompasses a group of psychotic disorders characterized
by disturbances in thought, perception, emotion, behavior and communication
that last longer than six months. In addition, the disorders are associated
with disability in work, school, social relations and independent
living skills. The cause or causes of schizophrenia is unknown. Genetic
factors may play a role, as identical twins and other close relatives
of a person with schizophrenia are more likely to develop the disorder.
Psychological and social factors, such as drug abuse, stressful life
challenges and interpersonal relationships, may also play a role in
development.
In identifying factors to recovery, Liberman and his team reviewed
a growing body of literature that show recovery from schizophrenia
can occur under two conditions: 1) when the disorder is treated early
with assertive case management and use of antipsychotic medication;
and 2) when more chronic or relapsing forms are treated for lengthy
periods of time with comprehensive, continuous care.
In addition, the researchers examined the cases of 23 schizophrenia
patients who met specific recovery criteria, including remission of
symptoms as well as successful functioning at work and school, independent
living and social relationships.
The National Institute of Mental Health and the National Alliance
for Research on Depression and Schizophrenia funded the study. UCLA
Neuropsychiatric Institute researchers involved in the study with
Liberman included Kopelowicz, Dr. Joseph Ventura and Dr. Daniel Gutkind.
The UCLA Neuropsychiatric Institute is an interdisciplinary research
and education institute devoted to the understanding of complex human
behavior, including the genetic, biological, behavioral and sociocultural
underpinnings of normal behavior, and the causes and consequences
of neuropsychiatric disorders. In addition to conducting fundamental
research, the institute faculty seeks to develop effective treatments
for neurological and psychiatric disorders, improve access to mental
health services, and shape national health policy regarding neuropsychiatric
disorders.
(relatively)
New Books on Schizophrenia:
October 4, 2002
No Sign Yet Of That Smoking Gun
Book Reviews By: Daniel Nettle
Note: Links below take you to the Amazon.com link for purchasing
the book. The Amazon link also has 25 pages of sample reading from
Nancy Andreasen's book for your review.
Brave
New Brain: Conquering Mental Illness in the Era of the Genome
By Nancy C. Andreasen Oxford University Press 368pp, Pounds 24.99
ISBN 0 19 514509 7
In
Search of Madness: Schizophrenia and Neuroscience By R. Walter
Heinrichs Oxford University Press 347pp, Pounds 32.50 ISBN 0 19 512219
4
Hardly a week goes by without our reading of a particular psychological
disorder that has been traced to a rogue brain chemical, or brain
area, or beyond that to a genetic variant. These two books, in their
different ways, reflect the fact that psychiatric research today sits
at the intersection of neuroscience and genetics, and a very long
way from the psychodynamic terrain it once occupied. Nancy Andreasen
is one of the ushers of this ongoing paradigm shift. Twenty years
ago, one of her books, The Broken Brain, became the general reader's
herald that the scientific consensus about psychological disorders
was shifting. Here she returns to survey the ground, choosing this
time the new genetics and brain scanning as the tools that are making
light the dark recesses of the mind. Andreasen's book is a solid enough
overview of some aspects of modern biological psychiatry. Her summaries
of the techniques of contemporary human genetics, and of brain scanning
and the cerebral architecture it reveals, are extremely clear and
useful. By the time she comes to survey the main psychological disorders,
though, she has run out of steam slightly. Thus, while these chapters
constitute useful introductions to schizophrenia, affective disorders,
anxiety and dementia for those who have no prior knowledge, there
is little in the way of synthesis of what we now understand to be
the nature of these disorders or of the puzzles that remain.
In the case of schizophrenia, for example, far from the twin searchlights
of genetics and brain-scanning locating a nice clean smoking gun,
they have revealed much more complexity and variability than we could
possibly have imagined. Despite some welcome words about the need
to avoid obstructive dichotomies (nature vs nurture, brain vs mind),
Andreasen is not prepared to engage with the possibility that neurobiological
research might make us question the whole conceptual framework - a
set of neat, discontinuous disease categories - that her book employs.
Anxiety and mood disorders, for example, are treated as separate chapters
in the book without comment, while genetic and neurobiological evidence
leads us increasingly to think of them as related or even different
aspects of the same thing. Many of the brain abnormalities (and some
of the genetic loci) associated with schizophrenia are also associated
with bipolar mood disorders, a crossover difficult to accommodate
within a discrete framework.
Perhaps most interestingly, contemporary neurobiological research
has revealed the presence of abundant variation within (and overlap
between) psychiatric populations and "normal" controls.
Because of this variation and overlap, for all our powerful scanning
and molecular techniques, we are still a long way from finding the
smoking gun, particularly in the case of schizophrenia. The gun in
this case would be some biological or genetic feature that was shared
by only and all individuals who suffer from schizophrenia. This feature
would be to schizophrenia what the cholera bacillus is to cholera
and the HIV virus to Aids, the pathognomon.
R. Walter Heinrichs's book takes us on a journey through the scientific
literature on schizophrenia in search of the pathognomon. The fascinating
thing about schizophrenia is not, as is sometimes alleged, that no
physical basis has been found to the illness. On the contrary, physical
differences between patient and control brains have been found in
terms of overall size, size of various sub-parts, gray-matter thickness,
neuronal density, neuronal orientation, size of cerebral ventricles,
dopamine activity levels, density of D2 and D4 dopamine receptors,
serotonin activity, glutamate... The list is almost endless. The problem
is knowing which of these manifold differences is significant, especially
since many of them have not proved consistent.
Heinrichs's methodology is so simple as to be beautiful, and produces
wonderful clarity in a confusing field. He meta-analyses the literature
on each of the pathognomic contenders. This is no mean feat since
2,000 research papers are published on schizophrenia each year. He
concentrates not just on the statistical significance of differences,
but on effect size, that is the magnitude of difference between patients
and controls. For each abnormality, he comes up with a mean-effect
size from the literature - a kind of balance sheet of the research
world's findings.
The results are most illuminating. First, despite a lot of variability
and non-replication, the balance of evidence shows that the brains
(and behaviours) of schizophrenia sufferers do differ significantly
from those of the rest of the population in multiple ways. Second,
there is no single trait that is much more pathognomic than any other
- no smoking gun. Third, the degree of difference is in no case very
great. On many measures, schizophrenic brains differ from the rest
of the population by about one standard deviation. This means that
they are measurably different, but there is a range of variation in
both patients and controls, and there is huge overlap between those
who receive the diagnosis of schizophrenia and those who do not. Thus
we have a huge amount of physical information that is all relatively
poor at identifying the individuals with the disorder.
These are important results to have. The physical basis of schizophrenia
is an area dogged by researchers narrowly pursuing their own favoured
abnormality, be it dopamine receptors, glutamate or neuronal migration,
without reference to other paradigms that are out there, and without
an attempt to achieve an overall synthesis. The frequency of non-replication
makes it difficult to know which results to rely on, and Heinrichs's
method solves that problem. The work is pursued with great clarity
and thoroughness. The only omission I noted was the failure to cover
differences of asymmetry and lateralisation in the schizophrenic brain.
Heinrichs struggles slightly to accommodate his findings within his
chosen conceptual framework. One explanation is that the abnormalities
we have discovered so far are not very illuminating because they are
not the key ones, but weakly related ones or side-effects, and further
research will find the real pathognomic culprit. The second explanation,
which he favours, is that there is causal variability within the schizophrenia
population, and so any single brain trait may characterise only some
sufferers. But I would have liked to see him go further. Taken individually,
the symptoms of schizophrenia are not uncommon within the "normal"
population. There are grey areas at the boundaries of psychosis, and
there is precious little reason to think that the behaviours labelled
schizophrenic represent an abrupt discontinuity with the behaviours
not so labelled. Thus it is perhaps not a huge surprise to find that
there is no abrupt discontinuity in the brains either. On the other
hand, and disproving the extreme constructionist arguments of the
anti-psychiatry movement, the differences are real. It is just that
they are about continua, rather than the all-or-nothing pathognomon
that the dichotomous nature of medical labels can make us assume should
exist.
In short, the new techniques of genetics, brain-scanning and the
like mean that we have no shortage of information about the basis
of psychological disorders. Heinrichs in particular has given us a
magisterial assessment of some of that evidence. The goal now must
be to synthesise it into a more satisfactory conceptual framework.
Daniel Nettle is lecturer in biological psychology, Open University.
The Last Taboo, a Survival Guide to Mental Health Care in Canada
Scott Simmie and Julia Numes are the authors of "The Last
Taboo, a Survival Guide to Mental Health Care in Canada,"
Toronto, McClelland and Stewart 2001 ISBN 0-7710-8062-X
The writing of that book was precipitated by Scott Simmie's breakdown
and recovery from major mental illness.
Purchase the book from Amazon Canada at:
The
Last Taboo - Amazon.ca
National Post (f/k/a The Financial Post)
October 3, 2002 Thursday National Edition
Mental, neurological ills to draw US$5B Pfizer spending
GROTON, Conn. - Pfizer Inc. plans to spend about US$5-billion during
the next five years to develop new treatments for neurological disorders
and mental illness. A Pfizer spokesman said the pharmaceutical giant
invested about US$1-billion, out of a total US$5.3-billion research
and development budget, into these disorders in 2002. The company expects
this commitment to continue for the next five years, making up the US$5-billion
total. Pfizer's Neuroscience Research and Development Program is developing
treatments for disorders such as depression and anxiety, epilepsy, Alzheimer's
disease, schizophrenia, neuropathic pain and migraine.
Is
paternal age linked to schizophrenia risk in offspring?
Men who have
a child in their advancing years may convey an increased risk of schizophrenia
to their child, reveals a team from the US.
Even after accounting
for maternal age and other confounding factors, the researchers found
that for every 10-year increase in the age of the father at the birth
of their child, the risk of that baby developing schizophrenia in adulthood
increased by almost 1.5 times.
Alan Brown (New
York State Psychiatric Institute, New York) and colleagues used data
from the birth cohort of the Prenatal Determinants of Schizophrenia
study to determine the relation of paternal age to schizophrenia or
other schizophrenia spectrum disorders in 71 patients.
Analysis of
paternal age as both a continuous and categorical variable revealed
a monotonic increase in the rate of schizophrenia spectrum disorders
with advancing paternal age categories.
Indeed, there
was almost twice the rate of adult schizophrenia spectrum disorders
in children of men who were 10 years older at the child's birth, irrespective
of adjustment for maternal age, paternal education, paternal race/ethnicity,
and parity.
When the risk
of schizophrenia alone was assessed, paternal age showed a similar dose-related
increase for risk as that found for schizophrenia spectrum disorders.
Discussing potential
explanations for their findings in the American Journal of Psychiatry,
the authors suggest a possible role of de novo mutations. These mutations,
which accumulate with advancing paternal age, result from replication
errors and defective DNA repair mechanisms that are thought to propagate
in successive clones of spermatocytes.
"While
further work is necessary to confirm this interpretation, our study
nonetheless provides further evidence that advanced paternal age is
a risk factor for schizophrenia spectrum disorders," the researchers
report.
Am J Psychiatry
2002; 159: 1528–1533
Schizophrenia drugs linked to diabetes
Last Updated Thu, 03 Oct 2002 15:11:37
HALIFAX - Some doctors are warning about a class of anti-psychotic drugs
linked to life-threatening side effects.
Health Canada has received reports that Zyprexa is suspected as the
cause of four diabetes-related deaths. The drug was approved for use
in Canada in 1996 and is made by Eli Lilly.
Zyprexa is part of a new class of drugs called atypical anti-psychotics.
A growing number of schizophrenics in the country are using the new
drugs, such as Clozaril. There are 300,000 schizophrenics in Canada.
People with schizophrenia experience three major types of symptoms:
psychotic symptoms: delusions and hallucinations
deficit symptoms: diminished emotions, social withdrawal and low motivation
mood symptoms: depression to suicidal
"It helps me by calming me down because I'm also nervous, my legs
shake and my hands tremble," says Richard Thompson of Edmonton
who has gained more than 30 pounds (14 kg) and developed diabetes since
taking the drugs. His doctors believe the drug is at least partly responsible
for his weight gain.
The most common side effects associated with Zyprexa are:
drowsiness
insomnia
agitation
dizziness
Less common effects include skin rash, depression, fast heart rate
and constipation
Other known, but less common, effects are listed as: skin rash, headache,
depression, fast heart rate, constipation and weight gain.
Research published in the British Medical Journal and other journals
suggest atypical anti-psychotics can cause diabetes.
"We suspect…those drugs interfere with some kind of chemical
processes both in the brain and body and lead to the development of
something called insulin resistance," says Dr. Pierre Chue, Thompson's
doctor. "As that develops, the diabetes sets in."
Health Canada has received four reports of diabetes-related Zyprexa
deaths over five years.
Two of those deaths involved teenage boys who fell into diabetic
comas.
In the U.S., the government has collected reports of 140 people who
developed diabetes after taking Clozaril.
The companies which make the drugs say people with schizophrenia
tend to have unhealthy diets which put them at risk of getting diabetes.
Marie Josee-Poulin, a psychiatrist at Laval University in Quebec,
says the evidence linking the drugs to diabetes isn't clear yet but
she says the concerns are justified.
A Health Canada newsletter has warned doctors that atypical anti-psychotics
may be associated with new cases of diabetes. Some doctors would like
to see this as a clear warning on the label.
Both Poulin and Chue says too many doctors are unaware of the risks
and side effects of the new class of anti-psychotics. They say patients
should be closely monitored for signs of unstable blood sugars or
weight gain.
Written by CBC News Online staff
-
The New York Times
September 15, 2002, Sunday, Late Edition - Final
When Politics Is Personal - (Senator Pete V. Domnici and the
shaping of the US Govt. policies on brain diseases/mental illness).
By Deborah Sontag; Deborah Sontag is a staff writer for the magazine.
'My daughter Clare, and it's spelled c-l-a-r-e, she's my fourth
child of eight," Senator Pete V. Domenici began reluctantly,
his voice soft and gravelly. "Clare was a beautiful, beautiful
girl. Now she's all grown up, and she's, well, she's struggling.
Struggle is a good word for it."
Domenici had been sitting beside me in an armchair in his Washington
office, chatting about a re-election race that is causing him little
anxiety. But when the conversation shifted to his family, and then
specifically to his 40-year-old daughter, Clare, he rose abruptly
and moved away, putting his solid senatorial desk between us. Sitting
beneath a Navajo wall-hanging from his native New Mexico, he absorbed
himself lining up pens on a yellow legal pad. A 70-year-old Republican,
Domenici is not a soul-bearing, confessional type, and he has zealously
guarded his family's privacy during his nearly three decades in
the Senate. "Personal stuff," as he calls it, makes him
squeamish; he'd rather talk about taxes or nuclear energy or almost
any piece of pending legislation. With what looked like a nod to
himself, however, he continued. "Clare was a very marvelous
gifted athlete," he said. "In her best year in high school,
she was district champion in tennis; she was a catcher on the baseball
team; she was an absolutely outstanding guard on the basketball
team." During her freshman year at Wake Forest in North Carolina,
however, Clare started to lose her zest, growing "fuzzy"
and inordinately indecisive. She would call home frequently for
guidance on simple issues, "like what kind of potato to have,"
Domenici said. "She was all out of whack. Then my wife, Nancy,
went down there to help her and ended up bringing Clare back home.
That's when things got really out of hand. Her temperament totally
changed. She became angry, mean. Throwing things at mirrors. Cussing,
swearing. Crying, shrinking into a shell, taking to her bed. And
that started two novice parents down the strange path of having
to believe something we didn't want to believe. And to really believe
it, to acknowledge that Clare was mentally ill, took a long time."
As Domenici exhaled, his assistant tiptoed in to give him a note,
and he asked her hopefully, "Meredith, do I have to go to an
appropriation meeting?" The assistant shook her head, but Domenici
had revealed all he wanted to about Clare for the moment. So he
switched gears and talked, in his distinctively folksy and rambling
way, about how the happenstance of Clare's illness had redirected
his political agenda. If it were not for Clare's struggle with what
was finally diagnosed as atypical schizophrenia, it is improbable
that Pete Domenici, Mr. Fiscal, would have assumed the unlikely
role of champion for the mentally ill. "I don't believe the
subject ever would have come up," he acknowledged.
Domenici had made a name for himself as the Republican Party's
budget expert. He was a gray, pragmatic fiscal and social conservative
who opposed abortion, gun control and same-sex marriage and supported
school vouchers, tax cuts and mandatory three-strikes sentencing.
He was no bleeding heart, no cause-pleader. But Clare's troubles
led Pete and Nancy Domenici into what, 18 years ago, seemed almost
like a secret world inhabited by all those whose lives had been
touched and ineluctably changed by mental illness. "And once
I got into it, I wouldn't have gotten out of it even if somehow
Clare would have come out of my mind," Domenici said. "You
get into the world of these dread diseases -- you hear stories --
they're terrible from the standpoint of what's happening to these
people and what's happening to their families. Society was just
ignoring them, denying them resources."
It is strange to think that government works that way, that the
fact that a senior senator has a mentally ill daughter can spur
governmental action on mental illness. Yet on many issues, politics
really is that personal and lawmaking that arbitrary. "You'd
be surprised how often legislation is directly informed by our lives,"
Lynn N. Rivers, a Democratic member of the House from Michigan,
says. "In the field of mental health, I think it's possible
that nothing at all would have been done by Congress if it weren't
for legislators like Domenici who were galvanized by personal experience."
Rivers herself has had very direct personal experience; she is a
manic-depressive. At a committee hearing this spring, after a couple
of witnesses suggested that mental illnesses were not really illnesses,
she snapped open her purse and extracted an amber vial -- the pills
that keep her healthy -- and shook it like a maraca as if to wake
them up.
Over a decade ago, when Domenici embraced the issue, mental illness
was not on the national agenda. Americans didn't like to think about
it. Even now, although the subject has come out of the shadows and
Prozac is in many an American medicine cabinet, Americans remain
skeptical and judgmental. Domenici knew that he was growing impassioned
about an issue that many of his colleagues would consider marginal,
even distasteful, and that he needed colleagues who had been shaken
personally, too. He ended up joining forces with a quite liberal
Democratic senator, Paul Wellstone, whose older brother had grappled
with severe mental illness for many years. Together the "odd
couple," in Wellstone's words, nurtured bipartisan alliances
with former Senator Alan Simpson, whose niece committed suicide,
and Senator Harry Reid, whose father killed himself, and Tipper
Gore, who has suffered depression, and Representative Marge Roukema,
whose husband is a psychiatrist, and Representative Patrick Kennedy,
who has also battled depression, and Senator Edward Kennedy, Patrick's
influential father, and Rivers. "There has been a personal,
crystallizing experience in each of our lives," Wellstone says.
"You almost wish it didn't have to work that way, that all
of us would care deeply anyway about people who were vulnerable
and not getting the care they need. But this kind of thing happens
a lot in politics for fully human reasons."
For 10 long years, Domenici and Wellstone have focused their energies
on a law that would force health insurers to treat mental and physical
illnesses with full parity. They consider it civil rights legislation,
but insurers and employers -- potent lobby groups who view it as
a costly and unnecessary new mandate -- have largely succeeded in
blocking it. Suddenly this year, however, the two senators feel
tantalizingly close to achieving what once seemed a nearly impossible
goal. It is odd timing, given the political preoccupation with terrorism,
corporate misconduct and Iraq. But perhaps, after "A Beautiful
Mind" won its Academy Awards, this was destined to be the year
when the mentally ill received their due. Or perhaps it is simply
because Pete Domenici has a friend in the White House, and his friend
owed him one, and that's the way the chit system known as government
works.
When we talked in his office, I asked Domenici if he kept a picture
of Clare in the extensive gallery of family photos behind his desk.
"Sure," he said. Then he peered over the top of his glasses
and rooted around. "Hmmm," he said. "Well. Hmmm.
Well. I guess I don't have her here, and I'll have to fix that."
He handed me a faded family portrait that looked to be from the
1970's. "That's her right there," he said, pointing to
a wan girl with a faraway gaze. "I guess she has a little sad
look in that one, doesn't she?" He then ambled over to a display
wall adorned with professional artwork from New Mexico. In one corner
hung two childlike watercolors -- a vase of flowers and a cluster
of sea gulls signed "To Dad, From: Clare." A flicker of
a smile crossed Domenici's face. "She's not half bad,"
the senator said.
The Domenicis live in Washington, down the street from the Ashcrofts
and a few blocks from the Senate in a house identifiable by the
red chili peppers -- New Mexico's state vegetable -- dangling beside
their front door. Clare lives by herself in an apartment in Albuquerque,
with two siblings, four aunts, a boyfriend, a case manager, a job
coach, a counselor and a doctor on hand to help her cope. Clare
does not have hallucinations or delusions, which is why her schizophrenia
is labeled atypical. Atypical schizophrenics suffer from losses
-- of will and drive, of the ability to experience joy and pleasure,
of cognitive functioning. Their affect tends to be flat and their
thinking irrational at times.
In Clare's case, this produces debilitating anxiety. Clare's younger
sister Paula Domenici, who is a psychologist, described Clare's
daily life as racked by "anguish and hell." Nonetheless,
like many atypical schizophrenics who respond well to the new low-dose
antipsychotic drugs, Clare has found a treatment regime that allows
her to be quite functional when she sticks to it. She works; she
drives; she sings in her church choir; she plays tennis at an Albuquerque
tennis club -- and wins," Paula says. But Clare's condition
fluctuates. Recently, she took a leave from her job sorting mail
because the stresses of the mail room were getting to her. "Any
little thing can rock the boat," Paula says. "She gets
very hurt very easily."
The Domenicis have grappled for years with how to balance their
daughter's right to, and need for, privacy against the potential
public good of talking openly about a senator's daughter's mental
illness. "We would ask ourselves, 'Will it do her harm or not?"'
Domenici said. And until now, they have always erred on the side
of playing it safe, since they are not people who like to talk about
themselves anyway. In our first conversation, Domenici squirmed,
his eye on his watch. Subsequently, though, he made the decision
to surmount his discomfort because he thought it might serve his
political ends. Besides, it was his wife who was the really private
one.
When I first called Nancy Domenici, who is considered a lay expert
on mental health by many in the field, she said: "Gosh, why
me? I'm not the most hep person on the subject of mental illness."
Eventually, her husband persuaded her to talk. "I didn't want
to end up divorced," she joked. Still, because she is either
protective or overprotective, she body-blocked the idea of my talking
directly to Clare. She said that Clare was simply too "wobbly"
right now.
We chatted at her kitchen counter, sipping tea from mugs with rose
handles beneath a clock that chirps a different birdsong on every
hour. At one point, after the finch cried noon, the phone rang,
and Nancy Domenici let the answering machine pick up. "Hi,
Mom, this is Clare." Clare was calling in to report to her
mother that she would be going to the doctor at 2 p.m. and to her
"weigh-in" at 4. (One side effect of her medication has
been a weight gain that makes Clare look matronly, and it bothers
her, her parents said.) Clare's voice sounded thick around the edges,
and it lingered afterward in the air between us.
In a senate coffee shop, with a cup of Starbucks by his side, Domenici
doodled on his daily press clippings. "Me/Bush," he wrote.
He told me he had always hoped that the stars would line up as they
now have, with a president in office whom Pete Domenici had helped
elect. "Here's how it worked," Domenici said. "He's
kind of my friend. He gets elected. I know there's one thing I really
want to do above most other things. I wait a few months after he
gets in, and then I request a meeting."
In 1996, Domenici and Wellstone enjoyed their first success after
four years of trying to overcome Congress's reluctance to address
the problem of inequitable and inadequate insurance coverage for
mentally ill Americans. Making a lot of compromises, they won approval
for what Domenici now calls "mental illness coverage lite,"
a first step. The Clinton White House helped, and especially Tipper
Gore, who a few years later would disclose her own experience with
depression. Newt Gingrich, then the Republican speaker of the House,
didn't actively assist but, after a visit from Domenici, he didn't
block the legislation either -- which mental-health advocates attribute
partly to the fact that Gingrich's mother suffers from bipolar disorder.
Still, the Mental Health Parity Act of 1996 was limited in nature
and in effect. It mandated equal annual and lifetime dollar limits
for mental and physical benefits; lifetime limits for mental-illness
coverage used to be capped at about $125,000, compared with about
$1 million -- or sometimes no limit -- for physical disorders. But
it allowed employers to comply with the letter rather than the spirit
of the law, shifting their costs by raising co-payments and deductibles
or lowering limits on hospital days and outpatient visits.
Many states, meanwhile, introduced mental-health parity laws that
go further than the federal government's. But even those states
possess limited ability to regulate self-financed employer health
plans, so Domenici and Wellstone wanted a broad piece of federal
legislation that would set the standard. With the 1996 law due to
expire by year's end anyway, they are pushing to create the first
comprehensive mental-health equitable treatment act.
Mental-health advocates say it will make things infinitely fairer.
Without parity, the middle-class parents of a newly psychotic 19-year-old
son, say, might discover they have a 30-day lifetime limit on psychiatric
hospitalization; that limit might be reached before his illness
is even diagnosed, much less treated. They would be left then with
three options: go into debt, forgo treatment or turn to the overburdened
public sector. If their son had been in a serious car accident,
they would face no such predicament.
The Domenici-Wellstone law does make some allowances for the business
community's concerns. It does not mandate coverage of mental illnesses;
it mandates equal treatment of physical and mental illnesses where
such coverage exists. It exempts businesses with less than 50 employees.
It doesn't include substance abuse. But insurers and employers are
tired of Congress's interference, and they do not see this as a
civil rights issue. "There is no right to health care,"
says E. Neil Trautwein, director of employment policy for the National
Association of Manufacturers. "If this issue gets cast that
way, it's unfair, and it kind of makes us look like the bad guys.
Our members are already providing voluntary coverage."
Many insurers and employers maintain that the parity legislation
is misguided, that it will end up backfiring and prompting some
providers to drop mental-health coverage entirely. They say that
parity for mental-illness coverage, as designed, will drive up health-care
costs and that the legislation defines mental disorders so broadly
that people with problems like caffeine intoxication or jet lag
will abuse the system.
Recently, however, these opponents have lost ground. While Domenici
had a couple dozen co-sponsors in 1992, when he first introduced
mental-health legislation, he now has 66 senators with him on this.
He has been unsuccessful, however, in reaching across the Hill and
persuading the House leadership to join him, even though a majority
of House members are on record as supportive. And that's why Domenici
paid his visit to the Oval Office in July of last year.
Domenici was pleasantly surprised that Bush took the issue seriously
enough to ask Andrew Card, his chief of staff, to attend. The senator
wasn't certain whether he needed to start at the beginning, to explain
that diseases of the brain are as real as diseases of other organs
and that they are treatable. "I just plain didn't know where
he was on the mental issue," Domenici said. "But I was
only a few sentences into it before he stopped me and said, 'On
the issue of is this a disease, I've already gone up that mountain."'
Dr. Samuel Keith, chairman of the psychiatry department at the
University of New Mexico, participated in a round-table discussion
on mental health with Bush in the spring. The president said that
he had grown up thinking people with mental problems should just
read the Bible and try harder, Keith said. But then, according to
Keith, the president told the round-table participants that a close
friend in Texas who was profoundly depressed went off and got treatment
and returned a transformed man. This opened his eyes, the president
said.
The president was also sensitized by the suicide last year of Heinz
Prechter, a Michigan businessman, Domenici said, although he was
not sure whether Bush had told him this or someone else had. Prechter,
who made his fortune after introducing the sunroof in the United
States and was a generous donor to the Republican Party, killed
himself at the end of a lifelong struggle with bipolar disorder.
During that meeting at the White House last year, Bush told Domenici
that 2002 would be a better year. In late April of this year, as
promised, Bush flew to New Mexico to stand beside Pete and Nancy
Domenici, endorse "full mental health parity" and pledge
to get federal legislation passed by year's end. Since then, Bush
hasn't put real muscle behind his pledge, and his priorities are
clearly elsewhere. Domenici, though, takes it on faith -- a seasoned
politician's faith -- that the president will make good on his promise.
And the mere fact of Domenici's securing the president's endorsement
has forced the law's longtime opponents to think about compromises.
"Our vast preference is no additional mandates, but we don't
want to be in an antagonistic position with a longtime friend like
Senator Domenici," says Trautwein of the manufacturers' group.
He suggested that the manufacturers would consider a narrower version
of the law that mandated parity for serious brain-based illnesses
like schizophrenia rather than all mental disorders. "We heard
the president, and we can count noses. We don't want to see this
issue rewound and replayed in the next Congress."
When the Domenicis told Clare that she was going to be part of
a magazine article, she didn't have much to say in response. It
has always been difficult for Clare to see her situation clearly,
her sister Paula says: "Sometimes now she'll say she has a
mental illness, which is good. Ten years ago, she wasn't coherent
enough in her thinking to realize she was ill."
Ten years ago was a low point. Clare, who was then still living
in Washington, would find herself driving around in a fog, unsure
of what she was doing or where she was. Eventually, she checked
herself into a psychiatric hospital. It was the first and last time
that she was hospitalized, her mother says, locked in a closed unit
with other mentally ill people, some withdrawn like her and others
quite manic or psychotic. During that time, though, Clare was retested,
and the Domenicis ended up with a clearer understanding of the chronic
nature of her illness and with a better course of medications.
It had been obvious since Clare dropped out of college that her
functioning was abnormal, but her family initially thought she was
in some kind of extended funk. Maybe it was allergies; it couldn't
have been that baseball that struck her in the neck, could it? They
didn't know where to turn. "We were kind of in the dark ages
in terms of being willing to see a specialist," the senator
told me.
Eventually, they found their way to specialists and more specialists.
But Clare's symptoms were not clear-cut, making it hard for doctors
to diagnose her condition and thus for some in her family to accept
that she was in the grip of something that she couldn't snap out
of. At a certain point, the senator said, so many years had gone
by that "you gotta acknowledge the behavior is not normal and
it's probably going to be there for a while."
That acknowledgment, he said, was scary. "When you finally
arrive at the conclusion that your child has schizophrenia, you
have thoughts of suicide," he said. "They threaten. You
really don't know if they're going to follow through. In our case,
nothing has happened. But we know friends where something has, and
there probably isn't a hell of a lot of difference between the one
who does it and the one who doesn't."
Some time after Clare's hospitalization, she moved back to New
Mexico. Her family thought that it would be a good idea to get her
out of urban D.C. and at something of a distance from her mother,
on whom she was extremely dependent. Clare lived for a while in
a group home near a state farm in Carlsbad, where she worked as
an assistant sports counselor for the mentally retarded residents
of the farm.
For a time, Clare was covered by Medicare, since she was collecting
Social Security disability insurance payments. Medicare's coverage
for mental health is quite skimpy -- only half of treatment costs
and no prescription drugs unless you're hospitalized. When Clare
started working, she was covered by her employer; the H.M.O. authorizes
a limited number of psychiatric visits a year, but Clare's doctor,
on her mother's prodding, keeps reauthorizing visits. Nancy Domenici
juggles the volumes of paperwork, keeps on top of the bureaucracy
and pays out of her pocket for all costs that are not covered. "What
if Clare had no parents?" she asks.
Years ago, a neighbor of the Domenicis told them about the National
Alliance for the Mentally Ill. The senator and his wife went to
a meeting in a church basement and discovered a world of parents
dealing with the same issues facing them. "It was a godsend,"
Nancy Domenici says. And for the alliance too. Pete Domenici heard
a lot of depressing stories with bad endings: families going broke,
splitting up; mentally ill children ending up on the streets, in
jail or dead. Bit by bit, the advocates lured Domenici into involvement,
a speech at a convention here, an appropriation there.
It became clear to Domenici that he could do little about one of
the most pressing needs, which is an overhaul of the public mental-health
system, since that is largely the responsibility of state and local
governments. So he focused on what he could get done. He pushed
successfully for increased federal appropriations for research into
brain diseases, threw his weight behind a private research foundation
and backed programs that dealt with housing, public education and
the mentally ill who are homeless. Every once in a while, he told
me, someone would say to him, "Isn't it good for severe mental
illnesses that your daughter got one of them?" He found that
distasteful.
Domenici never expected such a protracted battle on the parity
legislation, and he is tiring of it. Wellstone is downright antsy,
anxious about the president's follow-through. "I haven't seen
the evidence yet that the White House will deliver," he said.
"I'm certainly more impatient than Pete." But then they
are kind of different. Wellstone once called Domenici's office,
and an assistant asked him the subject of his call. "I answered:
'Mental health! What the hell else do we agree on?"' Wellstone
said.
Unlike Domenici, Wellstone speaks with the cogent passion of a
defender of the vulnerable and neglected. He fits more closely the
image one might have of a lead advocate for this cause. He traces
his political awakening itself to a visit he paid as a 10-year-old
to a state mental institution where his college-age brother had
been hospitalized after a breakdown. Wellstone's parents had gone
deep into debt trying to sustain his brother in a private clinic
once their insurance ran out, and the public hospital was a snake
pit, he says. "My energy on this issue is fired by tremendous
indignation," Wellstone says.
Rivers, similarly, is a natural heroine for the cause. She graduated
from high school pregnant, married her high-school sweetheart and
started her adult life as a mother bedridden by severe depression.
It took her almost a decade after her illness was diagnosed as manic
depression to find a mix of medications that would allow her to
be symptom-free. Eventually, though, she earned a law degree, became
active in local politics and was elected to Congress in 1994 despite
acknowledging her illness. ("You betcha!" she said when
a caller to a radio show, obviously a plant, asked if she had ever
been depressed. "And so have millions of other Americans!")
At times, she and her former husband, a boiler engineer, were spending
half their take-home pay on her barely insured treatment, so she
takes the parity issue very personally. The only possible explanation
for employers' and insurers' reluctance to cover mental illnesses
on a par with physical illnesses, she says, is "ignorance or
greed."
Last year, when Rivers learned that she would have to face Representative
John Dingell in a Democratic primary after her district was redrawn,
she was beset by anxiety. But not for political reasons. "The
one thing that frightened me was not running against the dean of
the House, not all the money he was going to have, but this terrible
fear that if I lost, I would lose my health insurance." Rivers
is covered under a federal employees' plan that guarantees full
parity coverage. "I am not smug enough to believe that I am
not at risk of relapse, and my terror is getting sick again without
having appropriate insurance," she said in July. Dingell did
indeed beat Rivers in the August primary, leaving her to face these
concerns.
In contrast to Wellstone and Rivers, Domenici can seem uninspired,
even inarticulate, in making his case. He uses euphemisms, talking
about mentally ill people as being "under the shell" or
"coming out from the shell" after treatment. He asks:
"Is a severe schizophrenic 19-year-old who's been catatonic
-- they finally got him out of it but now he's gained weight and
weighs 300 pounds because that's the side effect -- is that less
bad than someone with cancer?" But advocates for the mentally
ill believe that Domenici's folksy awkwardness on the subject of
mental illness can be quite effective, precisely because the subject
makes many Americans uncomfortable. And it is, they suggest, also
something of an act. Domenici's expertise is probably unparalleled
on the Hill, they say, and more important, it is his political know-how,
the way he bargains behind closed doors, that counts.
Andrew Sperling, legislative director for the National Alliance
for the Mentally Ill, says that Domenici has played a singular role
precisely because he is such an unlikely advocate. "If the
parity legislation had come along as a Kennedy-Wellstone initiative,
it would never have been taken seriously in the Senate. Democrats
come up with mandates on health insurance every day. But when a
senior Republican senator with a fairly conservative voting record
comes forward and says that in this instance the federal government
has a responsibility to set a standard on the marketplace -- it
has the flavor of a Nixon in China."
As year's end approaches, Domenici knows that Clare's law, like
Clare herself, needs to be watched and tended if it is not to be
overlooked or derailed. He hesitantly confided that he expected
Clare to marry in the near future, and it is clear that he is ready
for some kind of ceremony -- the Rose Garden, maybe -- on the legislative
front too. "We've been doing this for a long time," he
said, "and I am older than some people think."
September 20, 2002
Otsuka schizophrenia drug runs FDA gantlet
Chris Silva Staff Reporter
The FDA is nearing approval on a schizophrenia drug developed
by Rockville-based Otsuka America Pharmaceutical.
Otsuka, which was founded in Japan in 1921, received an
"approvable" letter from the Food and Drug Administration Aug.
29, after the bioscience company submitted data on its drug, Abilify,
following the conclusion of phase III clinical trials.
Abilify's final approval is contingent upon the completion
of ongoing discussions between Otsuka and the FDA.
"We still have a few issues that we have to address
with the FDA," says Wayne Laslie, executive vice president of sales
and marketing for Otsuka America.
Even so, Laslie says, the letter has given the company some
confidence that Abilify will make it to market as a successful anti-psychotic.
Otsuka estimates the U.S. market for anti-psychotic drugs is $5 billion
annually. Schizophrenia affects about 2.2 million Americans.
"There are a number of products in that market, but
Abilify was developed to meet unmet medical needs," Laslie says.
Abilify was discovered and developed by Otsuka researchers,
and will be co-marketed by Otsuka and Bristol-Myers Squibb.
The partnership between Otsuka and Bristol-Myers was formed
in 1999. Laslie says both company names would appear on promotional materials
and labels if Abilify is approved. He wouldn't disclose further details
of the arrangement.
Otsuka (http://www.otsuka.com)
is comprised of 32 businesses and 19,000 employees globally, earning total
revenue of $4.5 billion annually. Its global headquarters are in Japan.
Music fest raises big bucks for mental health
Sunday, September 22, 2002
By VIVI STENBERG-WILLIAMS
Register Staff Writer
Beautiful minds, music, wines and food proved to be a winning
combination at the eighth annual Music Festival for Mental Health at Staglin
Family Vineyards.
The Saturday event in Rutherford raised $2.4 million for
ongoing mental health research and treatment, thus confirming the festival
as the most successful wine-related, non-auction fundraiser in the country.
During the past eight years, total money raised is $10.9
million.
Although the festival has been a bona fide success since
its inception in 1995, founders Shari and Garen Staglin admitted that
"A Beautiful Mind," the novel and movie about mathematician
John Forbes Nash Jr.'s battle with schizophrenia, has contributed to peaking
people's interest in the subject.
"We have two goals that we work on: to raise substantial
funds for research and treatment and to raise awareness about mental illnesses.
The movie and the book were tremendous in helping us achieve both those
goals," Garen Staglin said.
Dr. Nash, his wife, Alicia, and New York Times reporter
Sylvia Nasar, who penned the intriguing biography, attended the festival
and were honored by organizers and participants.
At 21, Nash wrote a highly influential dissertation in which
he identified the theories of non-cooperative games. Eight years later,
in 1958, the mathematician started experiencing symptoms of paranoid schizophrenia
that virtually incapacitated him professionally for nearly two decades.
He later won the Nobel Prize.
Nash was not the only Nobel laureate attending the event.
The festival started with a two-hour scientific symposium
in which Dr. Eric Kandel captivated the audience with a historic look
at the scientific research on memory and new advances that can help in
the fight against mental illnesses such as schizophrenia.
Kandel, a Harvard Medical School graduate and professor
at Columbia University, was awarded the Nobel Prize in Medicine for physiology
in 2000. Kandel received the prize for his work on understanding the change
that takes place in brain cells when memories are formed.
In the audience sat a third Nobel laureate, Michael Spence,
who received the honor last year for his work in economics.
The warm day led to sweltering temperatures under the big-top
where the symposium was held. But instead of making a quick dash for the
cool wine caves and the elaborate wine tasting waiting for them, people
engaged in a question-and-answer session with Kandel following his speech.
When the session was over, close to 70 wineries poured wines
that were accompanied by hors d'oeuvres from Catahoula restaurant in Calistoga.
For about an hour and a half, Nash, Kandel and Nasar talked,
signed autographs and sipped wine.
The demure Nash was treated as a celebrity by the attendees.
For Mark Lachtman, himself a mathematician, the opportunity
of having Nash sign a copy of "The Essential John Nash" was
too good to pass up.
"He's like the Joe DiMaggio of mathematics," Lachtman
said smiling.
The presence of the man whose story inspired an Oscar-winning
film and made discussions regarding treatment of schizophrenia commonplace
was definitely a boon to the event.
"We're delighted that Dr. Nash could be here,"
Garen Staglin said.
Experiencing the detrimental effect of schizophrenia in
a close family member has been a catalyst for the Staglins commitment
to raising awareness for the disease.
Shari Staglin was all smiles Saturday, as people constantly
stopped to congratulate and thank her for her work.
"People can come here and talk about mental illnesses
and feel at home," Shari Staglin said. "There are no stigmas
attached, and we're able to raise a lot of money.
"It's pretty amazing, although some people's contributions
are down this year, most donations are up," she said, adding with
a laugh that she was carrying some of the late-arrival checks in her purse.
For some, a chance to taste rare wines was incentive enough
for supporting the cause.
Two Nebraska couples who attended the tastings had come
to both support the Staglins' work and drink spectacular wines, they said.
Although it was the third festival he attended, State Sen.
Wesley Chesbro, D-Arcata, said he too was deeply inspired by the event.
"The symposium was fascinating and gave great hope
for the future," Chesbro said.
Following the winetasting, attendees were treated to a performance
by the Staglin Chamber Orchestra under the baton of Maestro Carl St. Clair
of Orange County's Pacific Symphony.
For about 200 people, the event culminated in a $2,500-per-plate
dinner prepared by chef Josiah Citrin of Mélisse restaurant in
Santa Monica.
Nasar, who said she knew nothing of schizophrenia prior
to working on Nash's story, said the match of education, wine, music and
food was a good one.
"I don't think the match is trivial at all," Nasar
said. "Most of the time, the stories about schizophrenia are painful.
Coming to a delightful occasion like this, it invokes hope and generosity."
Vivi Stenberg-Williams
- California, US - LAURA'S LAW SIGNED BY GOVERNOR DAVIS
NEW LAW REFORMS TREATMENT OF SERIOUSLY MENTALLY ILL
GOVERNOR DAVIS SIGNS LAURA'S LAW 9/28/2002
'Laura's Law' Will Allow Court-Ordered Treatment Of Mentally Ill.
By Dan Morain And Carl Ingram, Times Staff Writers
SACRAMENTO -- Gov. Gray Davis signed legislation Saturday permitting
authorities to treat severely mentally ill people against their
will if
judges conclude that they cannot care for themselves and are likely
to
become dangerous.
The legislation represents a significant amendment to a state law
that
protects the civil rights of mentally ill people, the 30-year-old
Lanterman-Petris-Short Act. The act helped lead to the emptying
of
state hospitals, which once housed more than 30,000 people but now
care for
4,000. All but about 800 of those remaining patients have committed
crimes and were sent to institutions by courts.
The legislation, Assembly Bill 1421, establishes a hearing process
in
which judges will determine whether the person has a history of
failing
to comply with treatment and has, within four years, exhibited "serious
violent" behavior against others, or tried to hurt himself
or herself.
The individual could be represented by a public defender or a private
lawyer.
Davis said he expects the measure to help reduce homelessness,
hospitalization and involvement in the criminal justice system.
"This is a critical step in helping the seriously mentally
ill, as well
as their families," Davis said in a statement, predicting that
the bill
would "help end the cycle of hospitalization, quitting treatment
and
relapse."
Davis' decision to sign the bill marked a victory for Assemblywoman
Helen Thomson (D-Davis) in her final year in the lower house. Thomson
tried for five years to win approval of the measure, which was backed
by law enforcement and many family members of the mentally ill.
Liberals
in the Legislature, siding with some patients' rights activists,
had
blocked its passage until this year.
Thomson called the final version of the bill "Laura's law,"
named for
Laura Wilcox, a 19-year-old woman who worked at a Nevada County
mental
health facility and was killed by a man whose mental illness had
gone
untreated. It is similar to a New York law adopted in 1999 after
a
mentally ill man pushed 32-year-old Kendra Webdale into the path
of a
subway train.
As part of the compromise, counties will have the option of
participating, and would bear the costs. People would be treated
in
expanded outpatient programs considered the "least restrictive"
necessary to achieve recovery.
Under current law, people generally can be detained for 72 hours.
In
extreme cases, they can be held for six months. The law provides
parents and other family members of adults who are mentally ill
little or no
opportunity to intervene on the individual's behalf. Thomson's bill
will allow family members to testify at hearings.
"I don't think it will have any impact on the population in
state
hospitals," said Stephen W. Mayberg, director of the state
Department
of Mental Health. "Our goal is to treat people not in institutional
settings."
-
- New Web Sites of Interest:
- Nami India - www.namiindia.org
- an organization not yet affiliated with NAMI in the USA, but working
to obtain some level of affiliation.
-
New Research in Schizophrenia
Martin L. Korn, MD Disclosures
A number of interesting presentations and new research studies were
presented at the XII World Congress of Psychiatry in Yokohama, Japan.
Cognitive behavior therapy (CBT) has been widely used in the treatment
of depression and anxiety disorders. There is increasing evidence
that some of the techniques may be used in the treatment of bipolar
disorder and schizophrenia.[1] Turkington and associates[2] reported
on a study using psychiatric nurses to apply these techniques to outpatients
with schizophrenia. A total of 257 patients were administered 6 sessions
of CBT over the course of 6 months. The results were compared with
165 patients treated with treatment as usual. Patients administered
CBT demonstrated increases in insight, as well as decreases in overall
symptomatology scores and burden of care measures. Depression decreased
significantly as well. The effect at 9 months showed a significant
improvement in insight, negative symptoms, and career involvement.
This study therefore gave evidence that brief CBT interventions could
be delivered in a cost-effective manner by psychiatric nurses.
Depot Antipsychotics
Long-acting typical injectable medications have been shown to increase
compliance rates and thereby decrease rates of hospitalization.[3]
Atypical neuroleptics have also been shown to be more clinically effective
in decreasing rates of rehospitalization. For example, in a study
by Rabinowitz and colleagues,[4] the percent of patients remaining
in the community for 24 months was 52% for patients on typical neuroleptics,
67% who were treated with risperidone, and 69% treated with olanzapine.
Yet, the lack of availability of a long-acting atypical neuroleptic
has forced clinicians to choose between typical depot medications
with a generally higher side effect burden and atypical oral neuroleptics.
Long-acting injectable risperidone has recently been developed, which
should help to resolve this clinical dilemma. In a study by Remington
and colleagues,[5] patients with schizophrenia or schizoaffective
disorder were administered 25 or 50 mg of long-acting risperidone
every 2 weeks in an open-label study. A total of 397 patients were
included in the study. Partial hospitalization rates decreased from
7% prior to the study to 3% at the end of the study. Outpatient visits
also decreased significantly. Thus, long-acting injectable atypical
neuroleptics will be a significant addition to the pharmacopoeia in
the treatment of chronic psychotic conditions.
Sexual Dysfunction in Schizophrenia
Sexual dysfunction is increasingly being recognized as a problem among
patients with a variety of psychiatric disorders. The difficulty has
been widely recognized among patients with affective syndromes, in
part due to antidepressant-induced dysfunction. In individuals with
psychotic disorders, however, this problem has not received equal
clinical attention. Dossenbach and colleagues[6] conducted a study
that was a prospective observational study of health outcomes associated
with antipsychotic medications in patients with schizophrenia. All
care was at the discretion of the treating psychiatrist. Patients
were followed for a period of 3 years. Patients were drawn from Latin
America (35%), Africa and the Middle East (19%), Asia (17%), and Central
and Eastern Europe (29%). The patients enrolled in the study were
moderately ill. The overall presence of sexual dysfunction was 51%.
Patients from Central and Eastern Europe reported the highest levels
of overall sexual dysfunction (60%). The most severe cases of sexual
dysfunction were reported in Europe and Latin America. Patients in
Asia reported the lowest frequency and severity of dysfunction. The
overall sexual dysfunction rate in Asia was 32%. The most common symptoms
overall were loss of libido and impotence. There was also a significant
level of galactorrhea in all patients and amenorrhea. Physicians underestimated
the level of sexual dysfunction significantly.
Switching Neuroleptics During Treatment
The reasons why clinicians use a particular medication or class of
medication is important to understand to evaluate the quality and
nature of the decision-making process. This is particularly important
with the newer but more costly atypical neuroleptic medications. A
study in Germany assessed the prescribing procedures of 495 psychiatrists
in private practice via questionnaire.[7] The reasons why physicians
elected to continue or switch patients with schizophrenia to olanzapine
were evaluated. The most important reasons that clinicians utilized
olanzapine were perceived efficacy of the drug, improved side effect
profile and tolerability factors, lack of full efficacy of previous
treatments, type of psychopathology, and severity of illness. Although
the cost of the medication was seen as a problem, this did not influence
the clinical decision-making process.
Galantamine in Schizophrenia
Two interesting studies used galantamine in patients with schizophrenia.
J.P. McEvoy[8] investigated the impact of using galantamine to improve
smoking behavior. Preliminary findings with galantamine therapy have
shown improvement in episodes of agitation in 1 patient (8 mg twice
a day) and improved social and hygiene manners in another (12 mg twice
a day). The author concluded that there is hope in establishing a
therapeutic use for galantamine in patients with refractory schizophrenia.
A second study by Zhao and colleagues[9] described that patients
with schizophrenia suffer from significant cognitive deficits. Atypical
antipsychotic medications tend to improve these deficits compared
with typical agents. Nevertheless, cognitive difficulties still remain
a problem, even with the newer agents. Furthermore, the rate of cigarette
smoking among patients with schizophrenia is much higher than the
general population, leading to speculation about the role of nicotinic
receptors in psychotic disorders.
Galantamine is a reversible cholinesterase inhibitor approved for
use in Alzheimer's Disease.[10] The drug also acts at the nicotinic
acetylcholine receptors.[11] This nicotinic receptor action may relate
to the central cholinergic effects of the drug. McEvoy and colleagues
reported on preliminary results of a study examining the effect of
galantamine as a risperidone-augmenting agent in patients with schizophrenia.
All patients were on a stable dose of 1-8 mg of risperidone for at
least 7 days. Patients received 16, 24, or 32 mg of galantamine or
placebo over the 28-day course of the study. There appeared to be
some beneficial cognitive effects of this medication, particularly
on omission errors on the Conners Continuous Performance Test. Because
of the large variation in smoking rates, no definitive conclusions
could be drawn about the effect of galantamine on smoking.
*In this activity, the author may discuss investigational products
or unlabeled uses of FDA approved products.
References
Kingdon DG, Turkington D. The use of cognitive behavior therapy with
a normalizing rationale in schizophrenia. Preliminary report. J Nerv
Ment Dis. 1991;179:207-211.
Turkington D, Kingdon D, Turner T. Brief cognitive behavioural therapy
for schizophrenia. Program and abstracts of the XII World Congress
of Psychiatry; August 24-29, 2002; Yokohama, Japan. Abstract PO-74-3.
Youssef HA. Duration of neuroleptic treatment and relapse rate: a
5-year follow-up study with haloperidol decanoate. Clin Neuropharmacol.
1991;14(suppl 2):S16-21; discussion S22-23.
Rabinowitz J, Lichtenberg P, Kaplan Z, Mark M, Nahon D, Davidson M.
Rehospitalization rates of chronically ill schizophrenic patients
discharged on a regimen of risperidone, olanzapine, or conventional
antipsychotics. Am J Psychiatry. 2001;158:266-269.
Remington G, Duchesne I, Devos E, et al. Long-acting risperidone:
healthcare resource use. Program and abstracts of the XII World Congress
of Psychiatry; August 24-29, 2002; Yokohama, Japan. Abstract PO-73-25.
Dossenbach M, Brunner M, Becker S, et al. Sexual dysfunction during
treatment of schizophrenia: a largely underestimated problem. Baseline
results from the 3-year Intercontinental Schizophrenia Outpatient
Health Outcomes (IC-SOHO) study. Program and abstracts of the XII
World Congress of Psychiatry; August 24-29, 2002; Yokohama, Japan.
Abstract PO-73-41.
Linden M, Czekalla J, Holstein W, et al. Medical decision making when
switching neuroleptic treatment in schizophrenic patients to olanzapine.
Program and abstracts of the XII World Congress of Psychiatry; August
24-29, 2002; Yokohama, Japan. Abstract PO-73-47.
McEvoy JP. Galantamine's effect on smoking in schizophrenics. Program
and abstracts of the XII World Congress of Psychiatry; August 24-29,
2002; Yokohama, Japan. Abstract PO-74-10.
Zhao Q, Huang F, James R. Pharmacokinetics of galantamine and risperidone.
Program and abstracts of the XII World Congress of Psychiatry; August
24-29, 2002; Yokohama, Japan. Abstract PO-46-26.
Bonner LT, Peskind ER. Pharmacologic treatments of dementia. Med Clin
North Am. 2002;86:657-674.
Lilienfeld S. Galantamine - a novel cholinergic drug with a unique
dual mode of action for the treatment of patients with Alzheimer's
disease. CNS Drug Rev. 2002;8:159-176.
-
New Book: "Beyond Crazy" by Julia Nunes and Scott
Simmie, published by McClelland & Stewart. Sept 2002
ISBN 0-7710-8068-9 $34.99 Canadian dollars
********************************************
Toronto Star October 1, 2002
LENGTH: 1414 words
No looking back
By Julia Nunes and Scott Simmie
With the help of her mom, an indomitable young woman tames a terror
from the past
This is a tale of two generations. It's a sad story that leads to
a much happier one. And it begins in 1980, in the small Northern Ontario
city of Sault Ste. Marie. Terry-Lee Marttinen is 16 years old, dating
a young man named John (a pseudonym) when she discovers she's pregnant.
Something equally unexpected is happening to John. His behaviour has
become increasingly bizarre: he's smoking marijuana, dabbling in the
occult. Terry-Lee is scared; she stops seeing him.
Over the next four years, John winds up in and out of hospital. Much
later - too late - doctors determine he's been suffering from schizophrenia.
One summer day in 1984, when his daughter Tara is 3, John succeeds
after several attempts at suicide. He is 22 years old.
About a decade later, another young life is entering those delicate
teen years. And Tara Marttinen is herself beginning to feel different.
To the outside world, nothing is seriously wrong. After all, what
teenager doesn't stay up late or let their grades slip slightly?
Then one day as she sits at her desk in class, he hears, for the first
time ever, a voice in her head. "It was out of the blue. I heard:
'Take off your shoes and sit under your chair.' Really loud, sort
of screaming in my ear."
For the next several months she carries on with her classes, her meals
with her mom, and nights out with friends as if nothing's wrong. She
shares her secret with no one. But late at night, she lies awake for
hours, lost in a jumble of racing thoughts.
At 16, partway through Grade 11, Tara finally "spills the beans"
to her mother. And immediately, Terry-Lee thinks of schizophrenia.
"When she told me she was hearing voices, I knew instantly. Just
instantly. My little back went up and I was instantly fearful."
We meet Terry-Lee and Tara at a cafe in downtown Toronto. It's the
start of a mini-vacation they've been planning for weeks. Together,
they're visiting relatives, taking in the sights, and "shopping,
shopping, shopping."
Mother and daughter have matching blond hair, blue-grey eyes, and
friendly smiles. When one speaks, the other nods; often, they finish
each other's sentences.
"We've been together a long time," Terry-Lee says proudly.
"Just me and her. Being a young single mom, I think Tara and
I have been really close."
Tara nods in agreement. "I actually like hanging out with my
mom. ... It's relaxing to be around someone who understands you."
Tara is wafer-thin with finely carved cheekbones, alabaster skin,
and a small silver hoop through her left eyebrow just above her funky
black eyeglasses.
"We're very lucky," she says. "I'm very lucky."
Tara and Terry-Lee want to share the story of what's made them lucky.
Of how they got from there to here. There was Tara sitting alone in
her room, writing page after page of anguished poetry. Here is Tara
finishing high school with honours, Terry-Lee preparing to send her
off to university. "I'm relieved," Terry-Lee says. "I
was so scared. And now I know it's okay. I have a safe feeling inside."
The one thing Terry-Lee knew when she found out about the voices was
that Tara needed help away from home. "I just made the assumption
that the care wouldn't be any good in the Soo because of Tara's father's
care."
With a phone call to a distant uncle who worked in the mental health
field, Terry-Lee arranged an appointment at a clinic in London, Ont.,
seven hours away by bus. They didn't know it at the time, but what
they'd stumbled into was a leading-edge treatment facility for first-episode
psychosis. Dr. Ashok Malla runs the Prevention and Early Intervention
Program for Psychoses, or PEPP. Soon they were sitting in his office
as he led them through a clinical assessment.
Straight away, Dr. Malla recognized the early signs of psychosis.
Before he'd even diagnosed Tara with schizophrenia, he prescribed
a low dose of an atypical antipsychotic medication. "If we see
symptoms, if they've been there for more than a week, we treat them,"
Dr. Malla says.
Tara was also given a brain scan in a magnetic resonance imaging machine.
"That was the scariest thing," she says. "But I just
had this feeling: After this it's going to be better."
Tara was never hospitalized, never needed to be. Instead, she and
Terry-Lee returned home and went on with their lives.
Slowly, the voices faded away. But other challenges remained. Schoolwork
was harder than it had been, and even hanging out with friends could
be exhausting. "I missed, on average, one day a week out of school.
... I'd be wiped out. There was too much going on."
Tara was tackling head-on the kind of life changes none of her friends
were interested in making. Late-night partying gave way to quieter
activities: jewellery-making, journal-writing, embroidery. The junk
food was tossed - no more Cheez Whiz sandwiches - and replaced with
a high-protein, low-sugar diet bolstered with vitamins. (Terry-Lee
had done the research on
the Internet.)
Twice a year, mother and daughter made the long trip to London for
consultations with Dr. Malla.
If all this sounds simple, it hasn't been, as Tara wrote in a PEPP
newsletter: "I can't for even one day (diverge) from my regimen
of taking my vitamins, going through my day free of over-stimulation,
then taking my medication, and finally, going to bed at a decent hour.
If one of these elements were missing it would have drastic effects
on my performance the next day."
The payoff, however, has been huge. In five years, Tara has never
had a relapse. "I know when something's wrong," she says,
"and when I should rest."
Dr. Malla is thrilled with Tara's progress. "She has a vision
of her life," he says, "of what she wants to do."
What Tara wanted to do, after high school, was go to university. In
Sault Ste. Marie, that meant leaving home. "We're trying to be
realistic," Terry-Lee says. "Do the homework, cover the
bases, and then leap off the cliff."
The homework included choosing university in London, where Dr. Malla
is. Tara worked for a year after high school to save money. She applied
for student loans, and won scholarships to help pay for tuition and
books. And she decided against a room in residence - "too chaotic,
too much going on," says Tara.
Today, the results of all that can be found on a secluded street in
a clean and cozy apartment in an old house. This is Tara's new home,
the start of her new life. "I like living on my own right now,"
she says. "It's very comfortable. It's my own space."
Tara is pacing herself carefully. Taking three classes (English literature,
calculus, psychology) instead of a full course load of five. Keeping
the usual first-year socializing to a minimum. "I'm a loner anyway,"
she says with a self-deprecating laugh.
In her mind's eye, she carries a picture of the future. A four-year
honours degree in psychology completed over five years, including
summer classes and a full course load in the final year. After that,
a career counselling teens with mental health issues. Even further
down the road, she foresees marriage and kids, and perhaps a chance
to be medication-free. "If for some reason my brain's sort-of
levelled out again ... I don't want to be on meds and having kids."
But for now, she's focused on school. She says she's not even looking
for a boyfriend. "I don't want to be with a person who doesn't
respect my illness and understand the importance of it," she
says firmly. "It's a big part of my life. I don't want it to
be, but it is. It's something I have to deal
with, and they would, too, as a result of being with me. ... And I
don't think right now anybody's prepared for that."
Back at the cafe table, Terry-Lee shakes her head, amazed. "She's
wise. She freaks me out. But I understand why she's wise. Tara's spent
more time thinking about the meaning of life than most people do in
a lifetime."
Tara, slightly embarrassed, allows that she has "grown up fast."
But she finishes her thought in a way that reminds us she isn't too
grown-up just yet. "It's like you're sixteen," she says,
"and suddenly feel thirty, you know?"
Because the comment draws laughter from the rest of us at the table,
Tara - ever considerate - adds: "Forty, eighty, whatever. More
like eighty." Then, discreetly, she smiles.
Tara Marttinen is now in her second year of university. This is a
condensed excerpt from the book "Beyond Crazy"
by Julia Nunes and Scott Simmie,
McClelland & Stewart. ISBN 0-7710-8068-9
http://www.mcclelland.com/catalog/display.pperl?isbn=0771080689
-
Research yields better meds; Reducing side-effects, psychotic episodes
the goal
Windsor Star
BYLINE: Veronique Mandal Star Health-Science Reporter
Scientists attempting to design brain-shielding drugs for the mentally
ill are inching closer to curing schizophrenia.
"It could be tomorrow but it could also be 20 years from now,"
said Dr. Barry Jones, a researcher with the pharmacutical firm Eli
Lilly in Toronto.
Understanding the path to a cure begins with understanding how drugs
work on the schizophrenic brain. Anti-psychotics block the overproduction
of the chemical dopamine, particularly in the limbic system, an old
part of the brain which causes psychotic symptoms -- voices and paranoid
delusions. Newer drugs also treat more emotional symptoms such as
withdrawal and cognitive dysfunction. And they reduce the debilitating
motor side-effects which can produce Parkinson-like symptoms such
as the shakes.
The drugs also block another receptor for a chemical called seratonin
which makes the frontal cortex of the brain more active. In schizophrenia
the frontal cortex is slow and affects emotion and cognitive functioning.
The frontal cortex is the most highly developed part of the brain.
It develops last and is not complete until the mid-20s, when schizophrenia
typically develops.
"This is why schizophrenia could develop in younger children
but is not evident until the late teens," said Jones. "It
gives us our humanity, abstract thought, motivation and decision-making.
It's silent but dramatic. Psychosis is the noisy part."
Because repeated psychotic events destroy grey matter, Jones said
it's important to develop new drugs to prevent it. A chemical in Lilly's
drug olanzapine appears to do that in a small way.
"The aim is a brand new drug to protect the brain from psychosis,"
he said
Once the genetics of schizophrenia are better understood, Jones expects
the next stage to be a cure.
Traditionally, doctors have had difficulty keeping schizophrenics
on their meds. Anti-psychotic drugs cause everything from drooling
and lethargy to gross weight gain and possible links to heart disease
and diabetes.
Many schizophrenics get fed up having to take a dozen or more pills
a day.
McGill University psychiatrist Dr. Howard Margolese, a leading researcher
in the field, said while it's preferable to have patients on fewer
medications, it often takes several to deal with the symptoms.
"All anti-psychotics are effective against the positive symptoms
of schizophrenia but we have to use an anti-depressant if the person
is depressed and anti-anxiety medication if they're agitated and sometimes
they need a drug to counteract the side-effects," said Margolese.
A study in the British Medical Journal said the average annual cost
of keeping a person on anti-psychotics in Canada is $4,500. The average
cost to hospitalize that person is $39,000.
Newer drugs are more expensive and it can take years for patients
to be put on them. It is estimated that up to 60 per cent of Canadians
remain on older medications.
The newer drugs cost on average $2,000 to $10,000 per year compared
with $139 to $555 for drugs such as haldol, ORAP and loxapac. Prescription
drug plans vary across the country, but some demand use of less expensive
medications.
'Shattered minds'
Windsor Star
BYLINE: Veronique Mandal Star Health-Science Reporter
A century ago the mentally ill were imprisoned in asylums, given bizarre
treatments and restrained with strait-jackets, shoe locks, dress shackles
and gloves tied at the wrists.
None suffered more than schizophrenics. The illness was named after the
term "shattered mind," in 1911 by Swiss psychiatrist Eugen Bleuler.
It replaced the term dementia praecox, first used in 1899 by German psychiatrist
Emil Kraepelin who also first identified schizophrenia as a distinct mental
illness. Descriptions of its symptoms date back to Egyptian documents
in the second millennium before Christ. The word brain can be found in
the Smith papyrus, written in Egypt about 1700 BC and based on texts from
around 3000 BC. The Egyptians used temple sleep therapy, with a combination
of incantations and medical herbs.
Plato, in the fifth and fourth centuries BC, believed "divine"
madness created prophets, inspired poets and provoked an intense desire
for beauty.
Hippocrates, considered the father of medicine, argued that epilepsy,
madness and confusion were not caused by the gods, but by the brain. He
believed in humoral pathology -- an imbalance in body fluids -- and wrote
that "the disturbance is caused by a complex co-operation between
the outer environment and interior physical factors, including inheritance."
The belief that the mentally ill were possessed by the devil was widespread
and priests tried to cure them with medical herbs, magic and exorcism.
Treatments bordered on the bizarre in the 20th century. In the 1920s
it was fever therapies. In the mid-1930s schizophrenic patients were given
injections of camphorated oil.
During the 1940s and '50s more than 60,000 people in North America and
more than 9,000 in Scandinavian countries lost the frontal lobe of their
brains in the most notorious of all treatments -- the lobotomy. Portuguese
researcher Egas Moniz won the 1949 Nobel prize for an invention that cost
many their lives.
Anti-psychotic drugs were introduced in the 1950s, when pulverized roots
from the Rauwolfia serpentina bush were found to be useful in treating
psychotic anxiety. In 1952 Swiss researchers discovered its active ingredient,
reserpine, which was to become one of the most successful drugs in the
treatment of schizophrenia.
Windsor Star
October 10, 2002
Path of doom starts with homelessness; Squalor 'breaks your heart'
Windsor Star
BYLINE: Veronique Mandal Star Health-Science Reporter
Angela adjusts the grocery bag on her arm, unlocks the door to her schizophrenic
son's bachelor apartment and enters a rat-infested hole. She cries. "We've
complained to the landlord a hundred times but nothing gets done. It breaks
our hearts and we want to take him home but he wants to make it on his
own," says Angela, a Windsor mom. "He's not good at standing
up for himself and his paranoia works against him because the landlord
sees it and treats him like a dog. It's almost impossible for people like
him to get a decent place to live that they can afford."
Angela's story is repeated thousands of times across Canada, illustrating
the plight of the 25 to 60 per cent of the homeless who have a serious
mental illness.
Their homelessness sets up a vicious cycle of psychotic events leading
to hospitalization or incarceration, discharge to the streets and relapse.
"Without a proper home where they're stable, without someone to
keep an eye on them and an opportunity to have self-worth, they're lost,"
said Wendy Forrest, a mental health court case manager in Toronto. "There
are times when I visit a client and walk away in tears. It breaks your
heart to see where many of them end up."
Canada's largest city has 62,000 on its subsidized housing waiting list,
many of whom are mentally ill.
"There aren't even enough of the rat holes around let alone something
that's fit for human habitation and the people most often stuck on the
streets are the most seriously mentally ill," Forrest said.
The mentally ill, especially those with paranoid schizophrenia, often
prefer the streets to sleeping in a room with a dozen other people and
consider the street safer, she said.
In Windsor, where up to 50 mentally ill people per night are looking
for a bed, Laura Bedard of the Schizophrenia Society of Ontario said many
clients live in rest homes. They range from excellent to disgusting. About
11 private lodging homes house close to 400 residents.
"Some have bathrooms with no doors, some have co-ed bathrooms, substandard
food and sleep two to six in a room," said Bedard. "We hear
awful stories from people."
A major problem for the mentally ill is the way the government pays their
disability pensions. If they are in a hospital or in jail waiting for
a psychiatric assessment longer than 30 days, their pensions are cut off
and they lose their room or apartment. They come out of hospital or jail
and are forced back on the street.
Common symptoms of schizophrenia
Windsor Star
By Veronique Mandal
Poor concentration, scrambled thought patterns.
Flooding of memories from the past. Sensation that everyone is thinking
about and talking about you.
Sensations blunted or enhanced.
Inability to sort, interpret and respond and filter out the extraneous.
Delusions and hallucinations.
Paranoia.
Flattening of emotions, depression and feelings of guilt.
Inappropriate emotions and difficulty in assessing emotions of others.
Lack of spontaneity, withdrawal, immobility.
Catatonia and mutism, rigidity in the body and complete lack of speech.
Ritualistic behaviours including echolalia (repeating what is said by
others) and echopraxia (parroting behaviour). -- Source: U.S. National
Institute of Mental Health
Windsor Star
October 7, 2002 Monday Final Edition
SCHIZOPHRENIA: MYTHS VS REALITY
SERIES: SCHIZOPHRENIA
Windsor Star
By Veronique Mandal
Noted American psychiatrist Dr. E. Fuller Torrey has called schizophrenics
"the lepers of the 20th century." In an authoritative 1983 book,
Torrey, executive director of the Stanley Medical Research Institute in
Bethesda, Md., said too many schizophrenics live in a revolving door between
the streets, shelters, hospitals and jails.
For many, the word schizophrenia conjures up a mythical description of
frightening people. Images of "raving lunatics" are historically
portrayed in demonic poses, particularly in paintings depicting mentally
ill patients in hospitals such as St. Mary's of Bethlem in London, England.
In 2001, the release of the feature film A Beautiful Mind, portraying
John Forbes Nash's battle with mental illness, brought the mass audience
a realistic account of schizophrenia. However, many misconceptions remain.
Myth Their delusions are invented.
Reality The breakdown of the mind affects attention capacity and how
information is digested. Patients become disconnected from their environment,
causing them to have no reaction or a blunted, unpredictable reaction.
It can cause a lack of motivation and a preoccupation with ideas which
are important to them and no one else. The mind plays tricks -- you see,
feel and hear things that are not there and come to believe things that
are not true.
Myth Schizophrenia covers all mental disorders.
Reality Many conditions are frequently confused with schizophrenia, including
multiple or split personality, borderline personality disorder, street
drug or prescription drug psychosis, psychosis due to brain tumours, viral
encephalitis, temporal lobe epilepsy, cerebral syphilis, psychosis following
childbirth or trauma and infantile autism. Manic depression, or bipolar
disorder, is the only mental illness closely related to schizophrenia.
Myth Schizophrenics are moral degenerates.
Reality Schizophrenia is an organic disease that affects the function
and structure of a number of regions in the brain, affecting one per cent
of the population. A physical illness, no less than a broken bone or diabetes,
schizophrenia is not the result of moral deterioration. Nor are schizophrenics
inherently lazy or inhabited by demons.
Myth They have split or multiple personalities.
Reality Perhaps the worst misconception about schizophrenia. In fact,
multiple personality disorder is an entirely separate affliction, a severe
disorder involving a disturbance in memory and identity. People with multiple
personality disorder use idealization, denial or another strategy to cope
with trauma -- most often physical and/or sexual abuse -- experienced
in childhood.
Myth Schizophrenics are retarded.
Reality Mental retardation implies impairment of IQ, but an intelligent
person can suffer from schizophrenia and remain intelligent. The disease
most often strikes young people in their teens or early 20s. Boys in their
early- to mid-teens are most vulnerable because they have not had the
opportunity to complete their education or learn life skills. Girls often
are hit in their late teens or 20s, after they've completed secondary
school or have been in the workforce.
Myth They can't lead productive lives.
Reality The disease can be treated with medication and sufferers can
lead productive lives. Dr. John Bradford, professor and head, division
of forensic psychiatry at Royal Ottawa Hospital, is a champion of those
affected with schizophrenia. "With the medications we have today
and the tremendous research being done," he said, "people with
this disease can lead much fuller lives, but the quality of their lives
depends on people being better educated in the community."
Myth It's caused by overbearing mothers.
Reality An untruth which has caused devastation for parents who have
been told by psychiatrists that they were responsible for their children's
mental illness. Only in recent years has such thinking changed. What has
not changed is the stigma which causes families to hide the fact a loved
one has schizophrenia, instead attributing the condition to "nerves"
or "depression."
Myth Schizophrenics are stupid.
Reality Studies show that schizophrenics are often found to have an IQ
which is somewhat higher than that of the general population. Some have
special vision and insight as a result of their altered state, such as
artist Vincent Van Gogh, but most of the time the altered view becomes
an obstacle to their functioning. The severity varies with a range of
more than 40 symptoms.
Newcastle Herald (Australia)
October 2, 2002 Wednesday
HEADLINE: Study Scans Cannabis And Schizophrenia
BYLINE: By Lisa Allison Health Reporter
BODY:
PSYCHIATRIST Martin Cohen is comparing the effects of cannabis and schizophrenia
on the brain's ability to think.
Senior registrar in psychiatry from Newcastle's Centre for Mental Health
Studies Martin Cohen is using magnetic resonance imaging (MRI) scans of
people's brains to study their ability to function, comparing the effects
of cannabis and schizophrenia.
Using MRI scans, he is measuring the brain function of 30 people; 15
cannabis users who do not have a history of mental illness and 15 cannabis
users who have been diagnosed with their first episode of schizophrenia.
The study will focus on the function of the brain's frontal lobe, which
controls memory, concentration and a person's ability to socialise.
Some heavy cannabis users aged between 17 and 24 who have had their first
episode of schizophrenia had been scanned, Dr Cohen said.
The scans have been collected in the MRI scanner at John Hunter Hospital's
radiology department.
The study participants perform memory tasks while they are scanned.
'We are looking at how cannabis and schizophrenia affect the frontal
lobe of the brain and making a comparative analysis of the results,' Dr
Cohen said.
Cognitive impairments associated with the frontal lobe such as memory
and concentration loss, apathy and social withdrawal have been observed
in heavy cannabis users and people with schizophrenia.
Cannabis has a euphoric effect and a quarter of Australian adolescents
and 7% of adults use it regularly, Dr Cohen says. Studies show that cannabis
use amongst adolescents increases the risk of developing schizophrenia
by 2.5 times and up to six times in heavy users.
The MRI images will be taken of the study volunteers while they perform
a task test called the Tower of London, which is designed to activate
the brain's frontal lobe, showing up differences in the volunteers' ability
to cope with the tasks.
'We will be mapping the function activity of the brain as it is being
used,' Dr Cohen said. 'This is the first study to use these methods to
investigate how chronic cannabis use affects those structures and functions,'
he said.
Anyone wishing to participate in the study can contact Dr Cohen on 4924
6636.
HEADLINE: NSW: Study to probe pot smoking, schizophrenia link
BYLINE: By Judy Skatssoon, National Medical Writer
DATELINE: SYDNEY, Oct 1
BODY:
Researchers are using sophisticated brain imaging technology to show how
closely the changes produced by long-term cannabis use mirror those associated
with schizophrenia.
Martin Cohen, a senior registrar of psychiatry at the Hunter Centre for
Mental Health Studies, is studying people aged between 17 and 24 who have
smoked at least 2,000 "cones" in the past two years.
The study will compare the structure and functioning of the brains of
cannabis smokers with and without schizophrenia using magnetic resonance
imaging (MRI) brain scans. Chronic cannabis users experienced impaired
frontal brain functioning, which interfered with attention, memory and
concentration and was similar to some symptoms of schizophrenia, Dr Cohen
said.
"The reason we're doing this study is because the negative symptoms
of schizophrenia ... are very similar to the cognitive, or thinking deficits
induced by heavy and long-term cannabis use," he said.
"Cannabis affects the neural networks, or the architecture, of the
brain's prefrontal cortex in a similar way to schizophrenia."
Dr Cohen said the study would observe the brain after activating it through
the so-called Tower of London paradigm - a thinking task in which subjects
are asked to mentally rearrange a set of pegs.
He said he expected the brain scans to show less blood flow in the prefrontal
cortex as well as subtle structural changes in both cannabis users and
schizophrenics.
The effects were likely to be pronounced in cannabis users diagnosed
with schizophrenia, he said.
Dr Cohen said the study was targeting people in late adolescence because
this group was most at risk of suffering the undesirable effects of cannabis.
Previous studies showed adolescents who were heavy cannabis users increased
their risk of developing schizophrenia by up to six times.
"There's a public perception that ... cannabis is seen to be relatively
benign," he said.
"But it seems certainly in people with a mental illness, and in
an adolescent population, it does have some possibly quite serious effects."
A quarter of Australian teenagers and around one in 14 adults use cannabis
regularly.
The study is being conducted in collaboration with the Hunter Medical
Research Institute, the Neuroscience Institute for Schizophrenia and Allied
Disorders and the University of Essen in Germany as part of the Brain
Atlas initiative.
Pain & Central Nervous System Week
September 30, 2002
SECTION: EXPANDED REPORTING; Pg. 18
LENGTH: 252 words
SCHIZOPHRENIA: Miicro, Yale University School of Medicine to collaborate
on brain research
BODY:
Miicro, Inc., announced a research collaboration with the Yale University
School of Medicine focused upon understanding the underlying brain mechanisms
involved in schizophrenia.
The research will use Miicro's unique preclinical drug discovery and
development platform, which integrates Miicro's proprietary neuroimaging
technology with other measures to provide a powerful picture of brain
activity. Dr. Patricia Goldman-Rakic will lead Yale's contribution to
the research. "We are very excited about the opportunity to formalize
a collaborative relationship with Dr. Goldman-Rakic and Yale to learn
more about the basis of schizophrenia. Utilizing Miicro's neuroimaging
approach in combination with other approaches promises to provide new
insights about brain function and potential new therapeutics that could
not be obtained otherwise," said John Metz, PhD, chief scientist
of Miicro.
The research will use state-of-the-art techniques to provide insight
into the relationship of brain dopamine and serotonin and schizophrenia.
Miicro's OMEI (optimized metabolic effects identification) neuroimaging
method combines positron emission tomography (PET) imaging with proprietary
data collection and analysis techniques to objectively measure the subtle
effects of drugs upon the brain.
California Fund Raiser for Schizophrenia Research
In Napa Valley the same night, vintners Shari and Garen Staglin dedicated
their eighth annual "Music Festival for Mental Health" dinner/benefit/classical
music concert to Nobel laureate John Nash Jr.; his wife, Alicia; and author
Sylvia Nasar. They've raised awareness of mental health issues through
the book and movie "A Beautiful Mind," which chronicles John's
struggle with schizophrenia. Also honored: Nobel laureates Dr. Eric Kandel
(research on the brain) and Michael Spence (economics).
About 375 guests including Robert and Margrit Biever Mondavi, philanthropist
Dede Wilsey, and architect Sandy Walker helped to raise $2.5 million for
the National Alliance for Research on Schizophrenia and Depression. "Most
of the time, stories about schizophrenia are painful," Nasar said
in a statement. "Coming to a delightful event like this, it invokes
hope and generosity
San Antonio Express-News
September 26, 2002, Thursday , METRO
S.A. researcher helps in effort to find genes ; Scientists take on
schizophrenia
By: Cindy Tumiel
The search for genes related to schizophrenia has been long and frustrating
for scientists, who have spent years sorting through inherited traits
and outside influences that seem to contribute to this fairly common form
of mental illness.
Now, a San Antonio scientist is collaborating with researchers in Pennsylvania
on a different approach that is trying to identify risk factors for schizophrenia
and provide a way to screen for the people most at risk of developing
the disease.
Laura Almasy, an associate scientist at the Southwest Foundation for
Biomedical Research, compared the 2-year-old inquiry to the first research
into cholesterol, which now is used to assess the risk of heart disease.
"There is no cholesterol for schizophrenia," Almasy told a lunch
gathering of the Founder's Council, a group of the foundation's financial
supporters. "Like with most mental illnesses, we don't have anything
to measure to tell people what their risk is."
About 1 percent of the world's population has schizophrenia, a chronic
brain disease marked by disordered thinking, delusions, hallucinations
and paranoia.
There is strong evidence suggesting it runs in families, but development
of the disease seems to be influenced by other factors such as poor nutrition
or exposure to viruses in the womb as the brain is developing.
Almasy is working with scientists at the University of Pennsylvania in
Philadelphia and the University of Pittsburgh to identify the genes that
govern certain cognitive skills. Identifying these genes, she said, could
help predict who is at risk for developing schizophrenia and could lead
scientists to the actual genes responsible for it.
By adapting basic intelligence test questions, the researchers have shown
schizophrenics generally perform poorly on tests that measure the ability
to remember faces, complex shapes and vocabulary.
They also found that close relatives of schizophrenics show milder deficits
in these same skills, Almasy said.
For their study, the Pennsylvania scientists are recruiting families
in which at least two siblings have been diagnosed with schizophrenia.
Extended families will be tested and will submit blood samples for genetic
analysis.
Much of the genetics work will be done in San Antonio, where Almasy will
utilize sophisticated computers at the foundation that are capable of
performing the complex calculations necessary for genetic analysis.
"The idea is we've had a hard time getting to the genes responsible
for schizophrenia through traditional means," Almasy said. "We're
trying to get at them by identifying the genes that influence some of
these cognitive factors."
The Buffalo News
September 24, 2002
LENGTH: 1025 words
HEADLINE: OPENING MINDS;
FIRST THE BOOK, THEN THE MOVIE, NOW SOME PROGRESS ON UNDERSTANDING MENTAL
ILLNESS
BYLINE: PAULA VOELL; News Staff Reporter
What Sylvia Nasar wanted, mostly, was to tell the story of Nobel Prize
winner John Forbes Nash Jr., the mathematician whose delusions were as
persistent as the equations that filled his brilliant mind.
What she did with her book, "A Beautiful Mind," was to bring
mental illness to the attention of the American public, though it happened
mainly through the movie version and a stunning portrayal of Nash by Russell
Crowe.
Now, however, there is at least the beginning of an understanding for
what 2 million Americans experience with schizophrenia, as Nash did for
years.
"It was an incredibly intriguing notion that someone so lost could
recover from illness that we think of as a life sentence and get this
ultimate honor," said Nasar, who will speak on "A Beautiful
Mind: Genius, Madness, Reawakening" to a full house at the University
at Buffalo's Slee Hall Wednesday evening. Nasar said in a recent phone
interview with The News that she was overwhelmed by the intense response
to the movie. Though it contained some Hollywood touches (the scene where
colleagues present their pens as a token of respect to Nash never happened,
for one) and omitted chunks of the story she told in her book, Nasar praised
the Ron Howard directed movie for its portrayal of mental illness.
"This was the first time that one had a really inspiring, hopeful
story about someone with this illness," said Nasar, the Knight professor
of Journalism at Columbia University.
"Virtually all of the time, when there are stories in the newspaper
it's because someone's been pushed under a subway train. It's always most
horrific, tragic and really depressing stories.
"I'm not suggesting that one story has changed everyone's thinking,
but I think it does take a story like this to allow most of us to put
ourselves in the shoes of someone else," said Nasar, whose book won
the National Book Critics' Circle Award for Biography.
"People want to be entertained, but I think they left the theater
with a feeling of empathy that they didn't come in with.
"I don't think this story is the whole ball of wax, but it's a very
necessary step."
A crisis point
It's a story that needs to be told and retold, mental health experts say.
"Great strides have been made, but we also know that mental illness
still remains an easy target for poor taste," said Roger Stone, executive
director of the Mental Health Association of Erie County.
"The days when you could joke about gender or race are over, but
mental illness still remains."
That's ironic because the illness ranks in the top three of public health
problems and one in five adults will have a diagnosable form of the disease,
Stone said.
Nasar's work - which has made it easier to talk about the illness - raised
consciousness about mental health at a crucial time in public discourse.
There is a just-released report by the National Council on Disability
that says that the mental health system is in "crisis" because
it emphasizes medication rather than fostering ways to help the mentally
ill by providing housing, transportation and employment support.
And there is discussion in government quarters about insurance reform
to pay for treatment like therapy and counseling.
"There are people in Congress who have been active on insurance
issues about stronger parity legislation," Nasar said. "It won't
solve all the problems because a lot of mentally ill people don't work
and don't have insurance, but to establish the principle is vitally important."
Resurrection
Nasar wrote the story of Nash receiving the 1994 Nobel Prize for his 1950
dissertation on game theory, while she was covering economics for the
New York Times and became intrigued because he is one of the rare individuals
who "aged out" of the disease.
"Look, there are a lot of stories about brilliant rises and catastrophic
falls, right? To me, what was unique about the story was this idea of
a third act, after all these decades, a kind of resurrection."
For almost three years, she researched material for the book and interviewed
1,000 people.
But not Nash.
"He wrote me a note and said "Dear Ms. Nasar, I've adopted
Swiss neutrality,'" she said "though he was perfectly willing
to talk if we met at a dinner party or a meeting. He never gave me a formal
interview, but what was very critical was that he didn't prevent those
close to him, including his wife and children, from talking. This is very
unusual. Usually the subject will shut everybody else down."
John Nash's life stabilized, Nasar said, as his schizophrenic episodes
diminished and his life became incredibly richer after the Nobel.
"When he got the prize, he was a very different person than he is
today," she said. "He couldn't look you in the eye, he shuffled,
his teeth had rotted to the gums.
"But he has a life, last month he was touring China, he's doing
research again," she said. "A lot of that has to do with getting
all kinds of positive attention."
Nasar also credits the support Nash got from his wife and his own desire
to get better as critical to his recovery. "At a certain point, he
actively wanted to reconnect," she said. "But it's not wishing
your illness away, that's ridiculous. It's being able to put aside the
delusions and paranoid thoughts.
"What I've learned is that extraordinary things are possible, and
that it's not over until it's over," said Nasar of her experience
with Nash, who has become a friend.
For John Nash, it's not over yet. His youngest son, Johnny, who has earned
a doctorate, has schizophrenia and can't work. As his son's caretaker,
Nash drives him to pick up his "meds," takes him to outpatient
programs and bails him out of scrapes.
The disease that he came knew so intimately, that he worked to conquer,
isn't finished with him yet. It's just that now, he knows it from the
outside.
Nasar's talk is being sponsored by the UB School of Social Work, the
Erie County Anti-Stigma Task Force, the Erie County Department of Mental
Health, the Mental Health Association of Erie County and the Mental Health
Peer Connection.
Washington Business Journal, September 20, 2002
Otsuka drug approaching FDA approval
The FDA is nearing approval on a schizophrenia drug developed by Rockvillebased
Otsuka America Pharmaceutical.
Otsuka, which was founded in Japan in 1921, received an "approvable"
letter from the Food and Drug Administration Aug. 29, after the bioscience
company submitted data on its drug, Abilify, following the conclusion
of phase III clinical trials.
Abilify's final approval is contingent upon the completion of ongoing
discussions between Otsuka and the FDA. "We still have a few issues
that we have to address with the FDA" says Wayne Laslie, executive
vice president of sales and marketing for Otsuka America.
Even so, Laslie says, the letter has given the company some confidence
that Abilify will make it to market as a successful anti-psychotic. Otsuka
estimates the US. market for antipsychotic drugs is $5 billion annually
Schizophrenia affects about 2.2 million Americans.
"There are a number of products in that market, but Abilify was
developed to meet unmet medical needs," Laslie says.
Abilify was discovered and developed by Otsuka researchers, and will
be co-marketed by Otsuka and Bristol-Myers Squibb.
Lashe says both company names would appear on promotional materials and
labels if Abilify is approved. While Otsuka's largest market is in Japan,
the company is looking to broaden its reach.
"Our focus is global," says Hiromi Yoshikawa, Otsuka's chair
and CEO. "Our concentration involves three main areas in the development
of ethical drugs: cardiovascular, gastrointestinal, and neuroscience."
Otsuka America's other products on the market are Pletal, which combats
peripheral arterial disease; and Nitrolingual, a spray form of nitroglycerin.
Otsuka America was founded in 1985, and has a sister company in the area,
Otsuka Maryland Research Institute, which also is based in Rockville.
The two companies employ more than 500 people in the area.
Otsuka (www.otsuka.com) is comprised of 32 businesses and 19,000 employees
globally, earning total revenue of $4.5 billion annually. Its global headquarters
are in Japan.
September 17, 2002, Tuesday
HEADLINE: Psychiatric Genomics Announces a Collaboration with the National
Institute of Psychiatry and Neurology in Budapest, Hungary
DATELINE: GAITHERSBURG, Md., Sept. 17
BODY:
Psychiatric Genomics, Inc. ("Psychiatric Genomics"), a company
bringing an innovative approach to creating and developing small molecule
drugs for the treatment of mental illness, today announced a collaboration
with the National Institute of Psychiatry and Neurology (the "Institute")
in Budapest, Hungary, acting through Peter Gaszner, M.D., Ph.D., Director
and Professor of Psychiatry. The primary goal of this collaborative effort
is the eventual creation of novel therapeutics for the treatment of schizophrenia
and bipolar disorder, based on the analysis of samples from the Institute's
collection of central nervous system tissue from both normal controls
and individuals diagnosed with these debilitating disorders.
Under the terms of the agreement, Psychiatric Genomics will have an exclusive
collaboration with Dr. Gaszner to conduct research on brain tissue from
individuals diagnosed with bipolar disorder, schizophrenia, and other
psychiatric disorders. Using microarray technology, Psychiatric Genomics
will determine the patterns of gene expression and will use the data to
further its gene and drug discovery programs. New targets will be incorporated
into Psychiatric Genomics' novel Multi-Parameter High Throughput Screen(SM)
to discover effective treatments for bipolar disorder and schizophrenia.
In addition, Psychiatric Genomics will share all research information
with Dr. Gaszner and the Institute for use in its internal research programs.
The studies that will be undertaken by Psychiatric Genomics and Dr. Gaszner
will advance the neurobiological understanding of mental disorders and
will eventually lead to the development of novel therapies for these debilitating
disorders.
"Our collaboration with The National Institute of Psychiatry and
Neurology marks a significant step towards the advancement of therapies
for psychiatric disorders," commented Dr. Richard E. Chipkin, Chief
Executive Officer of Psychiatric Genomics, Inc. "Dr. Gaszner is a
recognized leader in this field and, combined with our 'systems biology'
approach to drug discovery, we are optimistic that the data resulting
from this collaboration will bring us closer to developing more effective
drugs."
"Psychiatric Genomics is an emerging leader in innovative drug discovery,"
added Dr. Peter Gaszner, Director and Professor of Psychiatry at the National
Institute of Psychiatry and Neurology. "Being the only drug discovery
company to analyze the gene expression patterns of human brain tissue
of patients suffering from psychiatric disorders, the company is on track
to revolutionize the way we treat these diseases."
About Psychiatric Genomics' Drug Discovery Approach
Psychiatric Genomics is the only biotech company that is basing drug discovery
for psychiatric diseases on human tissues. Through relationships with
various institutions, the Company accesses the central nervous system
tissue of normal controls and patients afflicted with illnesses such as
depression, bipolar disorder, schizophrenia and autism. The Company analyzes
these tissues using state-of-the-art microarray technologies and identifies
their distinctive gene expression patterns (the "disease signatures").
The disease signatures are combined with proprietary cell-based model
systems to form the basis of the Company's Multi-Parameter High Throughput
Screen(SM) (MPHTS(SM)) -- a revolutionary robotic system designed to find
small molecule therapeutics. The MPHTS(SM) determines the effects of new
chemical entities on the function of multiple genes simultaneously, thus
using the power of genomics to discover the next generation of psychotherapeutics.
The drugs developed through this approach have potential for improved
efficacy, reduced side effects and earlier onset of action.
About Psychiatric Genomics, Inc.
Psychiatric Genomics, Inc. creates and develops innovative small molecule
drugs to treat mental illness. Many of these diseases such as bipolar
disorder, schizophrenia, depression, and autism can be attributed to genetic
factors. Using human tissues the company identifies gene expression patterns
associated with psychiatric diseases. These data are incorporated into
Psychiatric Genomics' proprietary Multi-Parameter High Throughput Screen(SM)
to rapidly discover unique therapeutic compounds. For more information,
please go to http://www.psygenomics.com .
Marketletter, September 2, 2002
UK law and upcoming injectable drugs to treat schizophrenia and bipolar
disorder; Brief Article
Manufacturers of antipsychotic drugs are set to launch longer-lasting
injectable products which will help combat the problem of poor patient
compliance in the treatment of schizophrenia and bipolar disorder, says
new research from Datamonitor.
These drugs, which include Novartis' Zomaril (iloperidone) and Bristol-Myers
Squibb's Abilitat (aripiprazole), may have an important role if the UK
government's bill to force treatment of community patents is passed, because
they can ensure that the drugs are taken once every two weeks or possibly
monthly, it adds.
However, the study warns that antipsychotic injections are likely to
have mixed success. While they are particularly useful when treating patients
in the acute phase of schizophrenia, the length of efficacy may be subject
to controversy, as administering long-lasting medication decreases the
ability of the patient to influence their own treatment, which is considered
a patient right in most circumstances. In June 2002, the UK government
proposed several changes in the treatment of the mentally ill, one of
which will force patients in the community to undergo treatment without
the need to be sectioned. In this situation, a long-acting antipsychotic
would be particularly useful, says Datamonitor, because patients in the
community could visit a health care professional every two weeks, or possibly
every month, and compliance could be ensured.
A major issue in treating patients who suffer from spells of psychosis
is that, once their health improves, they are allowed into the community.
However, their chances of staying healthy are reduced because they are
not obliged to continue taking medication, says the report, which adds
that the introduction of longer-lasting drugs should increase patient
compliance greatly and, as such, help to reduce this risk.
Nevertheless, Datamonitor believes the future treatment of these disorders
will reside in receptor-specific compounds that can be combined into a
tailor-made polytherapy to suit an individual's needs, with movement towards
this type of therapy already being seen in early-stage programs.
Genomics & Genetics Weekly
May 31, 2002
HEADLINE: CNS DISEASE: U.S. patents issued for gene discovery technology,
gene target
BODY:
Genset, S.A. provided an update on its intellectual property portfolio
covering Genset's proprietary drug target discovery platform, and targets
it has identified in the field of Central Nervous System (CNS) disorders.
The U.S. Patent and Trademark Office has issued U.S. Patent No. 6,291,182
related to methods, algorithms, and software for identifying regions of
the genome that contain a gene associated with any detectable trait.
Genset also announced that it has received an allowance for a patent
application relating to the g72 gene, a new entry point for the treatment
of schizophrenia and bipolar disorder. The discovery of the g72 gene was
made possible in part by applying the technology covered by Patent No.
6,291,182. The g72 work was conducted as part of Genset's collaboration
with Janssen Pharmaceutica, N.V., a division of Johnson & Johnson,
Inc., which has an exclusive license to this gene. Genset retains rights
to further research conducted outside this collaboration, and namely to
other genes discovered in the metabolic pathway of g72. Claims for Patent
No. 6,291,182 are the first to cover biostatistical methods for confirming
that a candidate genomic region harbors a gene associated with a detectable
trait based on the frequency of SNP combinations known as haplotypes.
Many researchers now consider haplotypes to be superior for the discovery
of disease-related genes when compared with individual SNPs.
Daniel Cohen, Genset's director general of scientific strategy and a
coinventor of the patents, commented: "The technique covered by this
new patent allows researchers to compare the frequency of haplotypes in
candidate regions of the genome versus a noncandidate or random region.
We believe this technique will be key to deciphering the gene networks
involved in complex multigenic traits." Cohen continued: "The
technique developed at Genset and covered by the issued patent is highly
valuable for our on-going target discovery programs in CNS and metabolic
disorders, and can also be used to discover genes involved in the onset
of any number of other pathological conditions."
Using its integrated genomics technologies, Genset pinpointed the precise
location of a novel gene named g72. Genset's researchers established the
association of g72 with schizophrenia through extensive genotyping and
advanced biostatistical analysis. This association was then confirmed
in a separate population using an additional, well-characterized clinical
collection from schizophrenic cases and controls.
Genset's discovery of this gene has revealed a novel biochemical pathway
with new potential targets for drug discovery. Andre Pernet, PhD, president
and CEO of Genset, commented: "The g72 gene is only one of the several
promising discoveries in the field of CNS disorders our researchers are
working on. With Genset's experience in genetic association studies and
powerful technological platform, we are confident that our efforts will
continue to be successful in generating other targets for the development
of new drugs acting on causative mechanisms in humans."
Gene Therapy Weekly
May 2, 2002
HEADLINE: NEUREGULIN DEFICIENCY: Risk gene for schizophrenia identified
An international team of researchers led by Dr. Hans Moises of the University
of Kiel announced what appears to be a breakthrough in the search for
the causes of schizophrenia.
Two genetic markers on both sides of the neuregulin-1 gene on the short
arm of chromosome 8 revealed a highly significant association with schizophrenia.
The marker close to the neuregulin-1 gene is strongly associated with
the disorder thus identifying it as a major risk gene for schizophrenia.
The proteins of the gene are growth factors involved in the growth of
the brain, especially of its supporting cells, the so-called glial cells,
and of cancer, as well as of synaptic plasticity which is important for
memory, and of motor neurons. All these areas have been found in numerous
studies to be abnormal in schizophrenia. The discovery suggests a neuregulin
deficiency in schizophrenia that could be treated with neuregulin-1.
"The neuregulin finding shows the postulated connection between
the two major theories of schizophrenia, the genetic and the neurodevelopmental
hypotheses," said Dr. Irving Gottesman of the University of Minnesota.
It is also in agreement, according to Dr. Hans Moises, with his results
obtained in 2001 by another analysis which suggested among other risk
genes neuregulin-1 and a deficient protein synthesis of the brain as common
final pathway in schizophrenia.
A genetically engineered neuregulin-1, termed recombinant human Glial
Growth Factor 2 (rhGGF2), is already in late-stage preclinical development
as treatment for neurodegenerative diseases such as multiple sclerosis
at the Cambridge NeuroScience, Inc., in Massachusetts and the Bayer Corporation.
Therefore it seems to be possible that neuregulin-1 might soon be available
for the treatment of acute schizophrenic psychosis.
Gene Therapy Weekly, December 6, 2001
HEADLINE: DISEASE ASSOCIATION: Mother's Herpes Virus Infection Linked
To Schizophrenia In Children
Scientists at Johns Hopkins Children's Center and six other research centers
have found that mothers who have had a herpes simplex virus type 2 (HSV-2)
infection at the time of birth are more likely to give birth to children
who develop schizophrenia or other psychotic disorders.
HSV-2 is a sexually transmitted disease that differs from its common,
cold sore-causing cousin, HSV-1. Based on stored blood samples and medical
records dating as far back as the late 1950s, the correlative study in
the November 2001 Archives of General Psychiatry is the first to compare
direct laboratory evidence of specific maternal infections with the development
of psychosis in children. "The evidence shows some association of
maternal herpes simplex 2 virus with schizophrenia later in life,"
says Children's Center neurovirologist Robert Yolken, MD, a coauthor of
the study. "However, whether the herpes infection is a direct cause
or just a factor is still unknown."
Researchers drew their subjects from the Providence, Rhode Island, group
of the Collaborative Perinatal Project (CPP), a large-scale, nationwide
study that monitored 55,000 pregnancies at 12 study sites in the United
States between 1959 and 1966. The CPP also evaluated infants for physical
and mental development during the first seven years of life and stored
blood samples from mothers for later analysis.
Of the 3804 surviving offspring of 3078 pregnant women from the Providence
group, 27 children were diagnosed with schizophrenia or another psychotic
disorder. Fifty-four other mothers and children without psychotic disorders
from the Providence group were studied as a control group. The psychological
health of children in the study was assessed by medical record analysis
and telephone interviews. None of the offspring in the case group had
experienced encephalitis or other major neurological abnormalities at
birth.
The researchers determined maternal infection by the presence of elevated
levels of antibodies to HSV-2. Antibodies to other infectious agents,
including Chlamydia trachomatis (chlamydia), Toxoplasma gondii (toxoplasmosis),
rubellavirus (rubella), cytomegalovirus (viral pneumonia), the human papilloma
virus (genital warts), and HSV-1 (cold sores) were equally low in the
mothers of both psychotic and non-psychotic children. Because antibodies
to other sexually transmitted diseases were not different between the
groups, Yolken says sexual activity of the mother is not, by itself, a
predictive factor for the development of psychosis in their offspring.
Of the two major herpes simplex virus types, HSV-1 is extremely pervasive
in the human population and does not require sexual contact to be transmitted.
HSV-2 is rarer and more dangerous, and is typically transmitted sexually.
The replication of both viruses can be countered by antiviral medications.
Stephen Buka, ScD, and Ming Tsuang, MD, PhD, of Harvard's School of Public
Health and School of Medicine and the Harvard Institute of Psychiatric
Epidemiology and Genetics; E. Fuller Torrey, MD, of the Stanley Research
Laboratory; Mark Klebanoff, MD, of the National Institute of Child Health
and Human Development; and David Bernstein, MD, of the Children's Hospital
Medical Center in Cincinnati also contributed to the study. The Stanley
Foundation funded the study with additional support from the National
Institute of Mental Health.
Med Ad News, September 1, 2001
Schizophrenia Drug Market Status and Overview
Investor confidence was shaken in July 2001 when Novartis and development
partner Titan Pharmaceuticals Inc. (www.titanpharm.com) announced that
they would delay the regulatory submission of Zomaril to conduct more
clinical studies. The companies have initiated dose-related trials, including
once-a-day dosing, to more fully support the profile of Zomaril. The companies
are developing the product in Phase III clinical trials for the treatment
of schizophrenia. The additional studies will push back the first new
drug application submission to the Food and Drug Administration for Zomaril
to the end of 2002. The companies are planning studies in additional indications
such as acute mania. Titan and Novartis executives say their clinical
trials conducted to date support the favorable efficacy, safety, and tolerability
profile of Zomaril in the treatment of acute schizophrenia.
According to Merrill Lynch analysts, the schizophrenia market is valued
at about $ 1.75 billion and is projected to grow to around $ 3 billion
in 2005. Demonstrating a clinical advantage when compared with products
already on the market will be crucial for Zomaril's success. Because noncompliance
among schizophrenia sufferers is a widespread problem, Novartis managers
have decided to include additional once-daily dosing studies to Zomaril's
regulatory submissions. Merrill Lynch analysts say Zomaril's new drug
application will be delayed by at least six to eight months, resulting
in postponing the launch date to late 2003, thus the analysts reduced
their 2005 sales estimate from SFr344 million ($ 203 million) to SFr255
million ($ 150.9 million).
Dr. Vasella says he remains confident that Zomaril will be approved in
2003, as previously anticipated. Additionally, he told Med Ad News that
the delay in the launches of Xolair, Zelnorm, and Zomaril gives Novartis
an opportunity to improve its regulatory processes in the way marketing
processes were improved after the merger that formed the company in 1996.
In the absence of Zelnorm and Xolair, analysts at Sanford C. Bernstein
& Co. (www.bernstein.com) say Cox 189 and Zomaril are the most important
drugs in the pipeline to fuel future growth. If approved, Cox 189 will
compete with megabrands such as Vioxx, marketed by Merck & Co. (www.merck.com),
and Celebrex, marketed by Pharmacia Corp. (www.pharmacia.com) and Pfizer
Inc. (www.pfizer.com). Cox 189 is a nonsteroidal anti-inflammatory and
analgesic that belongs to the cyclooxygenase-2 inhibitor class of drugs.
Phase III trials are studying Cox 189's efficacy in treating osteoarthritis,
rheumatoid arthritis, and pain.
The antipsychotic market for which Zomaril is intended is dominated by
Risperdal, marketed by Johnson & Johnson (www.jnj.com), and Zyprexa,
which is marketed by Eli Lilly & Co. (www.lilly.com). "Both of
these markets are expected to continue to grow by double digits during
the next five years, so accessing even a minority share quickly contributes
significant revenue," says Catherine Arnold, senior research analyst,
European pharmaceuticals, at Sanford C. Bernstein.
Med Ad News, July 1, 2001
New Drug Development - Pfizer Overview
A potential successful new Pfizer product, Geodon, was launched in the
United States in March 2001. Discovered and developed by Pfizer scientists,
Geodon treats all the symptoms of schizophrenic psychoses and has a favorable
side-effects profile that causes little to no weight gain and has a favorable
effect on blood lipid levels. Sales of Geodon were $ 65 million in the
first quarter of 2001, largely reflecting the stocking of wholesalers
and pharmacies in the United States. Geodon could achieve sales of $ 1
billion by 2004, according to Merrill Lynch & Co. (www.ml.com) analysts.
Geodon was approved for marketing by the U.S. Food and Drug Administration
Feb. 5, 2001, in an oral form for the control of agitated behavior in
patients with schizophrenia and schizoaffective disorder. On Feb. 15,
2001, an FDA advisory committee recommended approval of this product in
injectable form. Pfizer shipped Geodon in early March and first promoted
the product to physicians in early April.
Discovered and developed by Pfizer, Geodon is a serotonin and dopamine
antagonist that is effective in treating the positive, negative, and depressive
symptoms associated with schizophrenia. Positive symptoms include visual
and auditory hallucinations and delusions. The harder-to-treat negative
symptoms include social withdrawal and lack of motivation. Depression
is a contributing factor to an estimated 10% suicide rate among patients
with schizophrenia. Schizophrenia is a chronic illness that requires lifelong
treatment and affects about 1% of the world's population.
In addition to demonstrated efficacy in treating schizophrenia, Geodon
was demonstrated to be weight-neutral, a feature that distinguishes the
product from all marketed atypical antipsychotics. Significant weight
gain, associated with many available antipsychotic medicines, is distressing
and stigmatizing to patients and often results in noncompliance.
Bristol-Myers Says Drug
Is Safe for Schizophrenia
DOW JONES NEWSWIRES
NEW YORK -- Bristol-Myers Squibb Co. said a study found that patients
being treated for schizophrenia could be safely switched to its aripiprazole
medication from other treatments.
The study switched patients to aripiprazole from olanzapine, risperidone
and haloperidol, reportedly without a loss of efficacy.
Bristol-Myers said Thursday that patients not only tolerated the switch
but also reported a reduction in certain side effects. Patients in all
groups reported weight loss.
At a satellite presentation at the 15th Congress of the European College
of Neuropsychopharmacology, Bristol-Myers also reiterated that a year-long
study of 1,294 patients showed participants receiving aripiprazole experienced
"significantly greater" improvements in negative and depressive
symptoms compared to patients treated with haloperidol.
In that study, aripiprazole showed "comparable" results to
haloperidol in maintaining response and improvements in patients' positive
symptoms, Bristol-Myers said.
Last month, Bristol-Myers and Japan's Otsuka Pharmaceuticl Co. received
conditional approval from U.S. regulators for aripiprazole, and said they
hoped to bring the drug to market later this year.
The drug, to be marketed as Abilify, was discovered by scientists at Otsuka
and is being developed jointly by Otsuka and Bristol-Myers.
Unlike most drugs used to treat schizophrenia, aripiprazole binds with
the brain's tiny receptors for the chemical dopamine without fully blocking
or stimulating them. As a result, the drug seems to moderate dopamine
levels, which are misaligned in the brains of people who suffer schizophrenia.
Because aripiprazole doesn't block dopamine receptors altogether, the
molecule doesn't appear to cause the stiffness and tremors in patients
that characterized the first generation of schizophrenia drugs. And since
it doesn't bind to some other receptors in the brain, it doesn't seem
to cause the troubling side effects including weight gain, sexual dysfunction
or an increased risk of diabetes.
About two million Americans suffer from schizophrenia, a frequently progressive
disease that causes hallucinations and delusions. Drugs to treat the disease
have been blockbusters. The current market leaders are Zyprexa, from Eli
Lilly & Co., and Risperdal, from Johnson & Johnson. Together,
the two drugs had sales of more than $3 billion in the past year.
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